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Morning Stiffness Significance — SCE Rheumatology MCQ

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EasyRheumatoid ArthritisMorning Stiffness SignificanceSCE Rheumatology

A 60-year-old man with established rheumatoid arthritis reports 90 minutes of morning stiffness. Examination confirms several swollen joints, and his DAS28-CRP is 4.8. Which statement best describes the significance of his prolonged morning stiffness?

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Reveal the answer and explanation

Correct answer: A — It supports active inflammatory RA but should be interpreted alongside composite disease activity.

Explanation lettering: E = shown as B · B = shown as C · C = shown as D · D = shown as E

A is correct. Prolonged morning stiffness is a characteristic inflammatory symptom and, together with swollen joints, supports ongoing active RA. However, stiffness duration is a subjective adjunct: studies demonstrate only weak-to-moderate associations with composite disease-activity measures, so it cannot quantify severity or determine treatment by itself. A DAS28 of 4.8 falls within the NICE moderate-disease range and is above the remission or low-disease-activity target, warranting treat-to-target review. Osteoarthritis generally causes less prolonged morning stiffness and does not explain the swollen joints. Structural damage may cause fixed limitation but does not adequately explain this inflammatory pattern. Morning stiffness neither independently establishes severe RA nor becomes irrelevant simply because it is omitted from DAS28.

Reference: Khan NA et al. Reevaluation of the role of duration of morning stiffness in the assessment of rheumatoid arthritis activity. Journal of Rheumatology. 2010. https://pubmed.ncbi.nlm.nih.gov/19833759/