Question

A 62-year-old woman presents with pain and stiffness in both hands and wrists for 3 months, worse in the morning for about an hour. Examination shows swollen, tender MCP and PIP joints bilaterally. What is the most appropriate next step in management in primary care?

Accepted Answer

Urgent referral to rheumatology and initiation of a disease-modifying antirheumatic drug (DMARD) such as Methotrexate under specialist guidance

Answer

Reassure and treat with simple analgesia alone

Answer

Order rheumatoid factor and delay referral until positive

Answer

Start long-term oral Prednisolone without referral

Answer

Order hand X-rays and review in 6 months

Practice question

A 62-year-old woman presents with pain and stiffness in both hands and wrists for 3 months, worse in the morning for about an hour. Examination shows swollen, tender MCP and PIP joints bilaterally. What is the most appropriate next step in management in primary care?