Question

A 50-year-old woman presents with 3 months of morning stiffness lasting more than 1 hour, pain and swelling of the metacarpophalangeal and proximal interphalangeal joints bilaterally and elevated inflammatory markers. Rheumatoid factor and anti-CCP antibodies are positive. What is the most appropriate next step in management?

Accepted Answer

Refer urgently to rheumatology and initiate a disease-modifying anti-rheumatic drug such as methotrexate unless contraindicated.

Answer

Start paracetamol only and observe for 6 months before referral.

Answer

Start long-term high-dose oral corticosteroids without disease-modifying therapy.

Answer

Delay treatment until erosions appear on radiographs.

Answer

Treat with non-steroidal anti-inflammatory drugs alone.

Practice question