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Rheumatoid arthritis — SCE Rheumatology MCQ

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EasyRheumatoid arthritisRheumatoid arthritisSCE Rheumatology

A 58-year-old woman has 4 months of symmetrical pain and early morning stiffness in the small joints of both hands. Examination shows bilateral MCP and PIP synovitis with reduced grip. Investigations show anti-CCP is positive and CRP is raised. The diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: C — Start methotrexate with folic acid

Start methotrexate with folic acid is the best answer because start methotrexate with folic acid is the most appropriate next step for rheumatoid arthritis in this clinical setting. Hydroxychloroquine is a plausible distractor, but it does not account for the key discriminator in the stem. Increase NSAID therapy and Prednisolone as long-term monotherapy would be more appropriate in a different clinical pattern or at another point in the pathway, while Hydroxychloroquine with analgesia is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions