Rheumatoid Arthritis Pathology

A 48-year-old woman from Delhi presents with a 6-month history of symmetrical polyarthritis affecting the PIP and MCP joints of both hands, morning stiffness lasting 2 hours, and constitutional symptoms. Laboratory investigations show RF 120 IU/mL (positive), anti-CCP 45 U/mL (positive), ESR 68 mm/h, and CRP 12 mg/dL. Plain radiographs of hands show no erosions. What is the most appropriate next step in management?

A 48-year-old man with established rheumatoid arthritis (disease duration 8 years) on methotrexate monotherapy presents with progressive joint swelling, morning stiffness of 90 minutes, and new subcutaneous nodules over his elbows. Recent labs: ESR 52 mm/hr, CRP 38 mg/L, RF 420 IU/mL, anti-CCP 145 U/mL. Hand radiographs show multiple erosions and joint space narrowing. He has tolerated methotrexate well with no hepatotoxicity. What is the most appropriate next step in management?

Which of the following is the primary pathological hallmark of rheumatoid arthritis in the synovial joint?

A 42-year-old woman from Delhi presents with a 6-month history of symmetrical swelling and morning stiffness (>1 hour) in her hands, wrists, and knees. On examination, she has soft tissue swelling of the PIP and MCP joints with ulnar deviation of the fingers. Laboratory investigations reveal: RF 85 IU/mL (positive), anti-CCP antibody 120 U/mL (positive), ESR 62 mm/h, CRP 18 mg/dL. X-ray of hands shows periarticular osteopenia and marginal erosions. Which of the following pathological processes is MOST directly responsible for the joint erosions seen in this patient?

A 38-year-old man with newly diagnosed seronegative rheumatoid arthritis (RF– and anti-CCP–) and moderate disease activity is starting disease-modifying antirheumatic drug (DMARD) therapy. What is the drug of choice for initial monotherapy?