A 36-year-old woman has 4 months of symmetric MCP and PIP pain and swelling with morning stiffness lasting 90 minutes. ESR is elevated and anti-CCP

Question

A 36-year-old woman has 4 months of symmetric MCP and PIP pain and swelling with morning stiffness lasting 90 minutes. ESR is elevated and anti-CCP antibody is positive. Radiographs show no erosions. Which of the following is the most appropriate next step in management?

Accepted Answer

Start disease-modifying antirheumatic therapy and refer to rheumatology

Answer

Start chronic prednisone as sole maintenance therapy

Answer

Immobilize both hands for 3 months

Answer

Reassure because radiographs show no erosions

Answer

Use opioid therapy as disease-modifying treatment

Rheumatoid arthritis — USMLE Step 3 MCQ

A 36-year-old woman has 4 months of symmetric MCP and PIP pain and swelling with morning stiffness lasting 90 minutes. ESR is elevated and anti-CCP antibody is positive. Radiographs show no erosions. Which of the following is the most appropriate next step in management?