Question 1

Question

A 32-year-old woman presents with a 6-week history of symmetric joint pain and swelling affecting her wrists, metacarpophalangeal joints, and proximal interphalangeal joints. She reports 2 hours of morning stiffness that improves with activity. Physical examination reveals warm, tender, swollen joints bilaterally. Laboratory studies show rheumatoid factor positive (1:320), anti-CCP antibody 180 U/mL (normal <20), ESR 65 mm/hr, and CRP 4.2 mg/dL. Apply the appropriate initial management strategy.

Accepted Answer

Begin methotrexate with folic acid supplementation and short-term low-dose prednisone bridge

Answer

Initiate biologic therapy with anti-TNF agent as first-line treatment

Answer

Start high-dose prednisone alone and reassess in 3 months

Answer

Prescribe NSAIDs and physical therapy, defer DMARDs until radiographic changes appear

Answer

Start hydroxychloroquine monotherapy

Rheumatology (autoimmune diseases, arthritis) — MCQs

Rheumatology (autoimmune diseases, arthritis) — MCQs

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