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Rheumatoid arthritis — CCFP MCQ

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HardMusculoskeletal and sportsRheumatoid arthritisCCFP

A 56-year-old woman has 3 months of bilateral hand pain and morning stiffness lasting 90 minutes. MCP and PIP joints are swollen. CRP is elevated and rheumatoid factor is positive. What is the most appropriate next step in management?

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Correct answer: E — Refer urgently to rheumatology and start symptom control while awaiting disease-modifying therapy assessment

Option E is correct. This patient fulfills criteria for early rheumatoid arthritis, including symmetric small-joint involvement, positive RF, elevated CRP, and significant morning stiffness. Evidence demonstrates that structural joint damage occurs early in RA and that early initiation of DMARD therapy improves long-term outcomes. Canadian primary-care guidance supports urgent referral to rheumatology and bridging symptom control (e.g. NSAIDs or temporary corticosteroids) while awaiting DMARD initiation. Option A misdiagnoses osteoarthritis; B defers definitive therapy; C unduly delays care; D risks irreversible damage by waiting for radiographic erosions.

Reference: Emery P et al. Early referral recommendation for newly diagnosed rheumatoid arthritis: evidence based development of a clinical guide. Ann Rheum Dis. 2002;61(4):290–7. https://pubmed.ncbi.nlm.nih.gov/11874828/ ; Bernatsky S et al. Care pathways in early rheumatoid arthritis. Canadian Family Physician. 2006;52(11):1444–5. https://www.cfp.ca/content/52/11/1444