skip to main content

Rheumatoid arthritis — SCE Rheumatology MCQ

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

ModerateRheumatoid arthritisRheumatoid arthritisSCE Rheumatology

A 69-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 team is planning baseline risk assessment and follow-up surveillance. The current consultation focuses on preventing morbidity rather than changing the diagnosis. What is the most important complication to screen for?

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

Reveal the answer and explanation

Correct answer: D — Atlanto-axial subluxation

Atlanto-axial subluxation is the best answer because rheumatoid arthritis is associated with atlanto-axial subluxation, which may be clinically silent until advanced. Methotrexate pneumonitis is a plausible distractor, but it does not account for the key discriminator in the stem. Coronary artery disease and Uveitis would be more appropriate in a different clinical pattern or at another point in the pathway, while Pulmonary arterial hypertension is suboptimal for this presentation. Clinical pearl: screening is most valuable when it detects a complication that is common, serious and clinically silent early in its course.

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