Rheumatoid arthritis — RACGP Fellowship MCQ
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Correct answer: A — Refer urgently to rheumatology while using symptomatic bridging care
Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E
This presentation—symmetric small‑joint arthritis with prolonged morning stiffness, elevated ESR, positive anti‑CCP, of eight weeks’ duration—indicates early rheumatoid arthritis. Australian RACGP consensus recommends referral when RA‑suggestive symptoms persist beyond six weeks, enabling early DMARD initiation within the ‘window of opportunity’ (within approximately three months of onset) for optimal outcomes. Symptomatic bridging therapy (e.g. NSAIDs or short‑term corticosteroids) may be used while awaiting specialist assessment. Reassurance (B) is inappropriate, as this delays necessary treatment; long‑term NSAIDs alone (C) ignore disease‑modifying therapy; injecting all MCP joints (D) is inappropriate systemic management; advising rest and avoiding exercises (E) is contrary to recommended rehabilitative care.
Reference: RACGP. Recommendations for the diagnosis and management of early rheumatoid arthritis. and Aust Prescr. Managing the drug treatment of rheumatoid arthritis. 2017. https://www.racgp.org.au/FSDEDEV/media/documents/Clinical%20Resources/Guidelines/Joint%20replacement/Rheumatoid-arthritis-recommendations.pdf