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Rheumatoid arthritis — SCE Rheumatology MCQ

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EasyRheumatoid arthritisRheumatoid arthritisSCE Rheumatology

A 24-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: B — Escalate to combination csDMARD therapy

Escalate to combination csDMARD therapy is the best answer because escalate to combination csdmard therapy is the most appropriate next step for rheumatoid arthritis in this clinical setting. Physiotherapy and review is a plausible distractor, but it does not account for the key discriminator in the stem. Prednisolone as long-term monotherapy and Increase NSAID therapy would be more appropriate in a different clinical pattern or at another point in the pathway, while Therapeutic exercise 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