skip to main content

Rheumatoid arthritis — SCE Rheumatology MCQ

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

EasyRheumatoid arthritisRheumatoid arthritisSCE Rheumatology

A 63-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: E — Switch leflunomide after methotrexate intolerance

Switch leflunomide after methotrexate intolerance is the best answer because switch leflunomide after methotrexate intolerance is the most appropriate next step for rheumatoid arthritis in this clinical setting. Urgent antibiotics is a plausible distractor, but it does not account for the key discriminator in the stem. Hydroxychloroquine and Start methotrexate with folic acid would be more appropriate in a different clinical pattern or at another point in the pathway, while Prednisolone as long-term monotherapy 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