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Rheumatoid arthritis — SCE Rheumatology MCQ

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ModerateRheumatoid arthritisRheumatoid arthritisSCE Rheumatology

A 29-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. Conventional therapy has been optimised and a biologic or targeted agent is being considered according to UK specialist practice. Infection screening has been completed and shared-care monitoring is in place. What is the most appropriate biologic?

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Correct answer: A — Rituximab

Rituximab is the best answer because rituximab best matches the disease domain and escalation pathway for rheumatoid arthritis. Ustekinumab is a plausible distractor, but it does not account for the key discriminator in the stem. Upadacitinib and Mepolizumab would be more appropriate in a different clinical pattern or at another point in the pathway, while Sarilumab is suboptimal for this presentation. Clinical pearl: biologic choice depends on disease domain, previous biologic exposure, comorbidity, infection screening and commissioning criteria.

Reference: NICE NG100; BSR biologic/targeted DMARD safety guideline; BNF