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Rheumatoid arthritis — SCE Rheumatology MCQ

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ModerateExerciseRheumatoid arthritisSCE Rheumatology

A 56-year-old woman with seropositive rheumatoid arthritis takes methotrexate and adalimumab. Her DAS28-CRP is 2.9, CRP is 4 mg/L and examination shows no swollen joints. She has chronic mechanical forefoot pain after prolonged walking due to established metatarsophalangeal subluxation, but no stress fracture, active synovitis or recent deterioration in foot symptoms. She has become sedentary, reports reduced lower-limb strength and wishes to improve her cardiovascular health. She has no exertional chest pain, uncontrolled hypertension or other contraindication to exercise. A specialist rheumatology physiotherapy service is available. Which exercise recommendation is most appropriate?

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

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Correct answer: E — Start tailored low-impact aerobic and progressive resistance exercise, building towards 150 minutes of moderate activity weekly and strengthening twice weekly

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

Her inflammatory arthritis is stable, so physical activity should be incorporated into standard care rather than postponed until formal remission. However, established forefoot damage and recent deconditioning require individual adaptation and graded progression. A low-impact aerobic modality, such as cycling, swimming or appropriately supported walking, can reduce forefoot loading, while progressive resistance training addresses her loss of strength. The intended progression accords with UK targets of 150 minutes of moderate-intensity activity weekly and muscle strengthening on at least 2 days. A is unnecessarily restrictive: aquatic exercise may be useful, but erosive damage does not mandate avoidance of all resistance or land-based activity. B uses a valid alternative aerobic dose, but immediate vigorous exercise and heavy loading are poorly matched to a sedentary patient requiring individualised progression. C identifies the correct moderate-intensity target, but walking may aggravate her forefoot symptoms and omission of resistance training neglects a core fitness domain. E is incorrect because low disease activity without active synovitis is not a reason to defer exercise; physical activity promotion is recommended throughout the disease course.

Reference: EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis: 2025 update (26 April 2026) — https://www.eular.org/document/download/1433/f6e7baaf-6357-42db-8b33-2ebc53927928/1351 UK Chief Medical Officers' physical activity guidelines (Updated 10 July 2026) — https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report/uk-chief-medical-officers-physical-activity-guidelines