Question

A 36-year-old woman presents with a 6-month history of pain and stiffness in the small joints of both hands, worse in the morning for over an hour. Examination shows tender, swollen MCP and PIP joints bilaterally. Rheumatoid factor is positive. What is the single most appropriate next step in management?

Accepted Answer

Urgent referral to rheumatology for consideration of DMARD therapy

Answer

Start long-term NSAIDs alone and review in 6 months

Answer

Order an MRI of the hands and feet before referral

Answer

Reassure her that this is likely osteoarthritis

Answer

Start long-term oral steroids without specialist input

Practice question