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Rheumatoid arthritis — SCE Rheumatology MCQ

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HardRheumatoid arthritisRheumatoid arthritisSCE Rheumatology

A patient with rheumatoid arthritis is in DAS28 remission with no swollen joints and normal CRP. Ultrasound requested routinely shows low-grade power-Doppler signal in one MCP joint. How should monitoring proceed?

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

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Correct answer: EContinue clinical monitoring; ultrasound should not drive routine escalation

Explanation lettering: C = shown as A · A = shown as C

E is correct. NICE advises against ultrasound for routine RA disease-activity monitoring. Imaging can answer selected diagnostic questions, but treating every subclinical Doppler signal has not shown sufficient benefit to replace validated clinical assessment and may cause overtreatment. DAS28 remission also does not justify abrupt DMARD withdrawal; treatment decisions remain individualised.

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