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Rheumatoid arthritis — MCCQE Part 1 MCQ

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ModerateJoint PainRheumatoid arthritisMCCQE Part 1

38-year-old woman presents with hand pain and morning stiffness. MCP/PIP joints are swollen symmetrically and stiffness lasts 90 minutes. Which of the following is the most appropriate next step?

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Correct answer: D — Refer early to rheumatology and start disease-modifying treatment pathway

Refer early to rheumatology and start disease-modifying treatment pathway is best because symmetric inflammatory small-joint arthritis suggests RA. Treat with topical therapy only despite systemic or red-flag features is suboptimal because local treatment alone is inadequate when systemic disease is possible; Delay assessment for several months is suboptimal because red-flag musculoskeletal or dermatologic presentations require timely assessment; Use antibiotics for every presentation is suboptimal because many rashes and painful joints are inflammatory, malignant or mechanical rather than bacterial; Provide opioids or reassurance as the sole management is suboptimal because symptom relief alone does not address diagnosis, function or safety. Early DMARDs prevent erosive damage.

Reference: Canadian Rheumatology Association RA guidance