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Seronegative rheumatoid arthritis — SCE Rheumatology MCQ

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HardInflammatory ArthritisSeronegative rheumatoid arthritisSCE Rheumatology

A patient has persistent symmetrical small-joint synovitis, negative RF and anti-CCP, and power-Doppler synovitis on ultrasound. What is the most appropriate next management step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Refer urgently for specialist rheumatoid-arthritis assessment and early DMARD treatment if diagnosed

The best answer is “Refer urgently for specialist rheumatoid-arthritis assessment and early DMARD treatment if diagnosed”. Persistent objective synovitis warrants prompt specialist assessment even with negative serology; rheumatoid arthritis is a clinical diagnosis and early DMARD treatment limits damage. The remaining choices—“Repeat the same ultrasound monthly before referral, within a rheumatology pathway, after safety review”, “Treat indefinitely with paracetamol alone, after safety review, after specialist assessment”, “Exclude inflammatory arthritis because serology is negative, after specialist assessment, with clinical reassessment”, “defer pending erosions before starting specialist care, with clinical reassessment, within a rheumatology pathway”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG100 rheumatoid arthritis in adults: https://www.nice.org.uk/guidance/ng100/chapter/Recommendations