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Rheumatoid arthritis — MCCQE Part 1 MCQ

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ModerateJoint PainRheumatoid arthritisMCCQE Part 1

A 39-year-old woman has 4 months of symmetrical pain and swelling in the MCP and PIP joints with morning stiffness lasting 90 minutes. Rheumatoid factor and anti-CCP antibodies are positive. Which of the following is the most appropriate next step?

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Correct answer: A — Refer promptly for rheumatology assessment and start disease-modifying therapy when confirmed

Symmetrical inflammatory small-joint arthritis with positive anti-CCP is highly suggestive of rheumatoid arthritis and early DMARD treatment improves outcomes. Opioids do not modify disease and waiting for erosions misses the therapeutic window. Osteoarthritis typically has brief stiffness and bony enlargement rather than synovitis.

Reference: Canadian Rheumatology Association rheumatoid arthritis recommendations