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Rheumatoid arthritis — SCE Rheumatology MCQ

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EasyRheumatoid arthritisRheumatoid arthritisSCE Rheumatology

A 49-year-old woman has 10 weeks of pain and early morning stiffness affecting the MCP, PIP and wrist joints. Examination shows symmetrical synovitis, squeeze tenderness at the MTP joints and no psoriasis. ESR is 58 mm/hour, anti-CCP antibody is strongly positive, rheumatoid factor is positive and hand radiographs show periarticular osteopenia without erosions. What is the most appropriate management?

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Correct answer: A — Start methotrexate with folic acid and arrange baseline monitoring

NICE and EULAR approaches support early DMARD treatment once rheumatoid arthritis is diagnosed, with methotrexate commonly used first-line unless contraindicated. Hydroxychloroquine monotherapy would be weaker for active seropositive polyarthritis, and waiting for erosions delays prevention of joint damage. Glucocorticoids may be used as bridging therapy, but they are not a substitute for prompt DMARD initiation.

Reference: NICE NG100; EULAR rheumatoid arthritis recommendations