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Rheumatoid arthritis — SCE Rheumatology MCQ

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ModerateLifestyleRheumatoid arthritisSCE Rheumatology

A 52-year-old woman with anti-CCP-positive erosive rheumatoid arthritis is reviewed after maintaining DAS28 remission for 14 months on methotrexate and adalimumab. She has no tender or swollen joints, her CRP is normal and she has no unstable or recently operated joints. She works from home, sits for approximately 10 hours daily and undertakes no regular exercise. Her BMI is 32 kg/m². Hypertension is controlled, and she has no exertional chest pain, disproportionate breathlessness or other cardiovascular symptoms. She wishes to improve her fitness but is concerned that aerobic or resistance exercise will reactivate synovitis or accelerate erosive damage. Which lifestyle plan is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Introduce an individualised, progressive programme combining aerobic and strengthening exercise while also reducing prolonged sedentary periods

Explanation lettering: E = shown as B · B = shown as C · C = shown as E

Her inflammatory arthritis is in sustained remission, and there is no joint, cardiovascular or postoperative feature requiring restriction of ordinary physical activity. She should be reassured that cardiorespiratory, muscular, flexibility and neuromotor exercise domains are feasible and safe in inflammatory arthritis. An individualised programme should progress towards general population targets—at least 150 minutes of moderate-intensity or 75 minutes of vigorous aerobic activity weekly, or an equivalent combination—with strengthening work and regular interruption of prolonged sitting. A is incorrect because obesity is an indication to support activity, not a threshold that must be crossed before aerobic or resistance exercise begins. B includes an appropriate aerobic target but incorrectly excludes muscular strengthening; erosive disease without active or unstable joints is not a contraindication. C is incorrect because aquatic exercise may be selected according to preference or impairment, but it need not replace safe land-based activity. D correctly recognises the independent value of reducing sedentary behaviour, particularly in an inactive person, but this should complement rather than indefinitely replace structured aerobic and strengthening exercise. NICE also recommends specialist physiotherapy access for people with rheumatoid arthritis to improve fitness and learn flexibility and muscle-strengthening exercises.

Reference: EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis: 2025 update (27 April 2026) — https://www.eular.org/document/download/1433/f6e7baaf-6357-42db-8b33-2ebc53927928/1351 Rheumatoid arthritis in adults: management (NG100) — recommendations (Recommendations current when checked August 2026) — https://www.nice.org.uk/guidance/NG100/chapter/recommendations