Morning Stiffness RA — SCE Rheumatology MCQ
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Correct answer: D — Stiffness lasting more than 30 minutes supports an inflammatory pattern, whereas shorter stiffness is more typical of osteoarthritis.
Explanation lettering: E = shown as A · A = shown as B · B = shown as E
D is correct. Early morning stiffness lasting more than 30 minutes supports persistent inflammatory synovitis, whereas osteoarthritis typically causes brief morning stiffness of 30 minutes or less. Thus, this patient's 45-minute duration is compatible with the inflammatory pattern of rheumatoid arthritis. However, duration should not be interpreted as a precise or standalone measure of RA severity: its correlation with composite disease-activity measures is weak, and current monitoring relies on measures such as DAS28 and CRP. A and B understate its diagnostic value. C is incorrect because morning stiffness is not a specific marker of infection. E reverses the usual distinction between inflammatory arthritis and osteoarthritis.
Reference: NICE, Rheumatoid arthritis in over 16s (QS33), Quality statement 1: definition of persistent synovitis, 2013. https://www.nice.org.uk/guidance/qs33/chapter/quality-statement-1-referral