QuestionSBA
QuestionChoice
This is correct. There are several signs of symptoms in this case that are characteristic of rheumatoid arthritis. Prolonged morning stiffness (>30 minutes) that improves throughout the day is a characteristic of inflammatory pain such as in rheumatoid arthritis. It typically features bilateral involvement of the small joints of the hand, and is more common in women, with typical age of onset between the ages 40-60 years old.
10025820
a
Rheumatoid arthritis
QuestionChoice
This is incorrect. Reactive arthritis is an inflammatory arthritis that typically occurs in the four weeks following an infection. It is also usually a monoarthritis, most commonly affecting the large joints of the lower limbs. Rheumatoid arthritis is therefore more likely in this case.
10025822
c
Reactive arthritis
QuestionChoice
This is incorrect. There are a few features of this case that make osteoarthritis less likely. Firstly, the patient is below the typical age of onset for osteoarthritis. The presence of morning stiffness that improves with activity, and involvement of the small rather than large, weight-bearing joints, is also indicative of an inflammatory arthritis such as rheumatoid arthritis.
10025821
b
Osteoarthritis
QuestionChoice
This is incorrect. Septic arthritis typically presents with an acutely painful, hot, swollen monoarthritis. Patients tend to be systemically unwell. The timeframe, multiple small joint involvement and normal observations seen in this case mean that rheumatoid arthritis is a more likely underlying diagnosis.
10025823
d
Septic arthritis
QuestionChoice
This is incorrect. Psoriatic arthritis shares many characteristics with rheumatoid arthritis and with this case. However, there are key differences. Psoriatic arthritis typically involves personal or family history of psoriasis, often including nail changes or dactylitis. These features are not mentioned in this case, making rheumatoid arthritis a more likely underlying diagnosis.
10025824
e
Psoriatic arthritis
Concept
Chapter
2693
3975
Rheumatoid Arthritis
Topic
146
Rheumatology
17562
A 44 year old woman presents to the GP with pain in both of her hands. The pain has been present for the last month and is worse in the morning; her hands feel very stiff all morning but later improve with movement. She is otherwise fit and well, and had no other medical conditions and no recent infections. She has been taking paracetamol for the pain to limited effect but has no regular medications.

On examinatio,n she has tender, red, swollen metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints bilaterally. All other joints are unremarkable. Her observations are all within normal limits.

Which of the following is the most likely underlying diagnosis?
a