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Reactive arthritis — SCE Rheumatology MCQ

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EasySpondyloarthropathiesReactive arthritisSCE Rheumatology

A 38-year-old man develops asymmetric oligoarthritis 3 weeks after dysuria. Examination shows there is enthesitis and conjunctival injection. Investigations show rheumatoid factor is negative and urine NAAT confirms chlamydia. 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 — Treat underlying infection

Treat underlying infection is the best answer because treat underlying infection is the most appropriate next step for reactive arthritis in this clinical setting. Ustekinumab is a plausible distractor, but it does not account for the key discriminator in the stem. Start methotrexate with folic acid and Referral for biologic assessment would be more appropriate in a different clinical pattern or at another point in the pathway, while Mycophenolate mofetil 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