skip to main content

Severe active rheumatoid arthritis after csDMARD failure — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardInflammatory ArthritisSevere active rheumatoid arthritis after csDMARD failureSCE Rheumatology

A 53-year-old woman has erosive rheumatoid arthritis with DAS28 6.2 despite optimised methotrexate and sulfasalazine, with negative TB and hepatitis screening. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: B — Escalate to biologic therapy with methotrexate if suitable

The best answer is “Escalate to biologic therapy with methotrexate if suitable”. Escalate to biologic therapy with methotrexate if suitable is the most appropriate next step after the disease phenotype, previous treatment and safety constraints in the stem are considered. The remaining choices—“Palindromic rheumatism, after safety review, within a rheumatology pathway”, “Erosive osteoarthritis, after specialist assessment, after safety review”, “Hydroxychloroquine monotherapy, with clinical reassessment, after specialist assessment”, “Etanercept, within a rheumatology pathway, with clinical reassessment”—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