A 60-year-old woman has morning stiffness lasting over an hour, symmetrical swelling of small hand joints and positive anti-CCP antibodies. What is the most appropriate treatment?
Answer and explanation
Correct answer: A. Early disease-modifying antirheumatic drug such as methotrexate
- Step 1: Features match rheumatoid arthritis.
- Step 2: NICE NG100 advises early DMARD therapy to prevent joint damage.
Answer
Early disease-modifying antirheumatic drug such as methotrexate.
Why not the others: Allopurinol to lower urate: Allopurinol treats gout. Paracetamol only, with the first specialist review in a year if symptoms persist: Paracetamol alone is inadequate. Long-term regular opioids alone, to control pain until the joints stop swelling: Opioids do not alter disease.
Practise more Infection, haematology, rheumatology and acute care.
Free questions with an explanation for every one, and full timed PLAB 1 (GMC, international medical graduates) mock tests.
More Infection, haematology, rheumatology and acute care questions
- A 50-year-old man returns from West Africa with fever on day 8. Which is the most important investigation?
- A healthcare worker has a needlestick injury from a patient known to be HIV positive with a detectable viral load. When should post-exposure…
- A 22-year-old student has a fever, severe headache, neck stiffness and a non-blanching rash. He is in the GP surgery. What is the immediate…
- A patient with neutropenia after chemotherapy has a temperature of 38.5 degrees Celsius. What is the correct action?
- A 67-year-old man develops a red, hot, swollen knee with a temperature of 38.4 degrees Celsius. What is the priority?
- A woman collapses with hypotension and hyponatraemia, hyperkalaemia and hypoglycaemia. She has pigmentation of her palmar creases. What is t…