Seropositive rheumatoid arthritis — SCE Rheumatology MCQ

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EasyRheumatoid arthritisSeropositive rheumatoid arthritisSCE Rheumatology

A 52-year-old woman has 4 months of morning stiffness and painful swelling of both hands. Examination shows synovitis of the second and third MCP joints and wrists. Investigations show CRP 34 mg/L, RF positive, anti-CCP strongly positive and hand radiographs with early marginal erosions. What is the most likely diagnosis?

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Correct answer: D — Seropositive rheumatoid arthritis

The diagnosis is seropositive rheumatoid arthritis. The discriminating features are persistent symmetrical synovitis of the wrists and MCP joints, prolonged morning stiffness, raised CRP, positive RF, strongly positive anti-CCP antibodies and marginal erosions. Psoriatic arthritis is less likely without psoriasis, nail disease, dactylitis or a characteristic asymmetric or distal interphalangeal pattern. Erosive osteoarthritis usually affects the DIP and PIP joints and produces central rather than marginal erosions. SLE arthropathy is usually non-erosive, while polymyalgia rheumatica causes predominantly shoulder and hip-girdle symptoms rather than persistent small-joint erosive synovitis.

Reference: National Institute for Health and Care Excellence. Rheumatoid arthritis in adults: management (NG100), sections 1.1.1–1.1.6, 2018; last updated 2020, recommendations amended 2024. https://www.nice.org.uk/guidance/ng100/chapter/Recommendations