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Hand osteoarthritis — SCE Rheumatology MCQ

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HardOsteoarthritis and Soft Tissue RheumatologyHand osteoarthritisSCE Rheumatology

A 66-year-old man has DIP and first CMC pain, Heberden nodes, thumb-base squaring and morning stiffness lasting 10 minutes. What is the most appropriate management?

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Correct answer: E — Use hand exercises, splinting and topical NSAID where appropriate

The best answer is “Use hand exercises, splinting and topical NSAID where appropriate”. Use hand exercises, splinting and topical NSAID where appropriate is the most appropriate next step after the disease phenotype, previous treatment and safety constraints in the stem are considered. The remaining choices—“Start methotrexate with folic acid and monitoring, after safety review”, “Begin high-dose glucocorticoids immediately, after specialist assessment, after specialist review”, “Urgent joint aspiration and culture, with clinical reassessment”, “Use NSAID therapy and physiotherapy, 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 NG226 osteoarthritis: https://www.nice.org.uk/guidance/ng226/chapter/Recommendations