skip to main content

Rheumatoid arthritis — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

EasyRheumatoid arthritisRheumatoid arthritisSCE Rheumatology

A 33-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?

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

Reveal the answer and explanation

Correct answer: A — Treat-to-target review in 3 months

Treat-to-target review in 3 months is the best answer because treat-to-target review in 3 months is the most appropriate next step for rheumatoid arthritis in this clinical setting. Start methotrexate with folic acid is a plausible distractor, but it does not account for the key discriminator in the stem. Sulfasalazine monotherapy and Increase NSAID therapy would be more appropriate in a different clinical pattern or at another point in the pathway, while Stop DMARD treatment 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: NICE NG100; BSR biologic/targeted DMARD safety guideline; BNF