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Rheumatoid arthritis — SCE Rheumatology MCQ

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EasyRheumatoid arthritisRheumatoid arthritisSCE Rheumatology

A 24-year-old man 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 admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: B — Rheumatoid arthritis

Rheumatoid arthritis is the best answer because the pattern described is most consistent with Rheumatoid arthritis, including the distribution of symptoms and the targeted investigation results. SLE arthritis is a plausible distractor, but it does not account for the key discriminator in the stem. Osteoporosis and Osteomalacia would be more appropriate in a different clinical pattern or at another point in the pathway, while Giant cell arteritis is suboptimal for this presentation. Clinical pearl: in SCE-style questions, the decisive clue is usually the pattern across joints, extra-articular features and targeted immunology rather than a single antibody result.

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