Rheumatoid arthritis — SCE Rheumatology MCQ

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EasyInflammatory ArthritisRheumatoid arthritisSCE Rheumatology

A 48-year-old man has 10 weeks of symmetrical MCP, PIP and MTP swelling, 90 minutes of morning stiffness, raised CRP, positive rheumatoid factor and strongly positive anti-CCP; radiographs are normal. What is the most appropriate management?

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Correct answer: E — Start methotrexate with folic acid and safety monitoring

Start methotrexate with folic acid and safety monitoring is the single best answer because persistent small-joint synovitis with anti-CCP positivity supports early rheumatoid arthritis before erosions appear. The stem is testing management choice, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Palindromic rheumatism is less suitable because it fits a different clinical pattern or a different treatment threshold; Erosive osteoarthritis, Hydroxychloroquine monotherapy and Etanercept do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: NICE NG100; BSR rheumatoid arthritis guideline; BNF