Rheumatoid arthritis — SCE Rheumatology MCQ

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EasyInflammatory ArthritisRheumatoid arthritisSCE Rheumatology

A 43-year-old woman has 4 months of pain and swelling in the MCP and PIP joints of both hands. Morning stiffness lasts 90 minutes and she has difficulty making a fist. ESR is 48 mm/hour, RF is positive and anti-CCP antibody is strongly positive. Hand radiographs show periarticular osteopenia without established erosions. What is the most likely diagnosis?

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Correct answer: B — Rheumatoid arthritis

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

Rheumatoid arthritis is best because symmetric small-joint inflammatory synovitis with prolonged morning stiffness and high-titre anti-CCP is most consistent with early rheumatoid arthritis. A is less suitable because erosive osteoarthritis targets DIP and thumb-base joints with short-lived stiffness; C is less suitable because psoriatic arthritis would usually have psoriasis, nail disease, dactylitis or an asymmetric pattern; D is less suitable because viral polyarthritis is usually acute and self-limiting rather than 4 months of progressive synovitis; E is less suitable because SLE arthritis is often non-erosive and would be supported by lupus features or specific serology. Clinical pearl: anti-CCP is highly specific and predicts a greater risk of erosive disease.

Reference: NICE NG100; EULAR RA management recommendations 2022