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Rheumatoid arthritis — SCE Rheumatology MCQ

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EasyInflammatory ArthritisRheumatoid arthritisSCE Rheumatology

A 51-year-old man is newly diagnosed with rheumatoid arthritis after 10 weeks of bilateral wrist and MCP synovitis. He has no renal or liver disease and drinks little alcohol. CRP is 42 mg/L and baseline FBC, U&Es and LFTs are normal. He asks what disease-modifying treatment should be started. What is the most appropriate management?

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

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Correct answer: C — Start methotrexate with folic acid

Explanation lettering: E = shown as B · D = shown as C · B = shown as D · C = shown as E

Start methotrexate with folic acid is best because methotrexate is the usual anchor csDMARD for active rheumatoid arthritis and should be started promptly with folic acid and monitoring. A is less suitable because hydroxychloroquine monotherapy is less suitable for active moderate disease with raised CRP; B is less suitable because prednisolone alone may be used as short bridging therapy but does not provide adequate disease modification; C is less suitable because watchful waiting risks preventable erosive damage; E is less suitable because etanercept is considered after inadequate response to csDMARDs and eligibility criteria are met. Clinical pearl: the SCE commonly tests early DMARD initiation rather than prolonged symptomatic treatment.

Reference: NICE NG100; BSR csDMARD guideline 2025