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Seronegative rheumatoid arthritis — SCE Rheumatology MCQ

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HardInflammatory ArthritisSeronegative rheumatoid arthritisSCE Rheumatology

A 78-year-old man has persistent symmetrical wrist and MCP synovitis, prolonged morning stiffness, raised ESR, negative rheumatoid factor and negative anti-CCP. Ultrasound confirms power-Doppler synovitis. What is the best next step?

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Correct answer: C — Refer for specialist diagnosis and disease-modifying treatment planning

The best answer is “Refer for specialist diagnosis and disease-modifying treatment planning”. Persistent objective small-joint synovitis warrants urgent rheumatology assessment even when rheumatoid factor and anti-CCP are negative. Repeating serology should not delay care, osteoarthritis does not explain Doppler synovitis, biologic therapy is not the initial unconfirmed treatment, and seronegativity does not exclude rheumatoid arthritis.

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