Rheumatology 101-150 MRQ

A 58-year-old man presents to the emergency department with acute onset of left knee swelling, redness, and pain that began 24 hours ago. He is febrile and unable to bear weight. The joint is warm with a large effusion and restricted range of motion. He denies any recent trauma or known autoimmune disease. You suspect septic arthritis and plan the initial diagnostic workup.

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A 42-year-old woman presents with acute monoarthritis of the right ankle. The joint is swollen, warm, and exquisitely tender. She has had fevers and malaise for 2 days. She has no history of autoimmune conditions or recent injury. You suspect septic arthritis and are considering the best investigations to confirm the diagnosis and assess systemic involvement.

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A 66-year-old male with a background of type 2 diabetes presents with acute swelling and severe pain in his left knee. He is febrile and tachycardic. The joint is warm, erythematous, and tense. Arthrocentesis yields purulent fluid with >100,000 WBC/mm³ and positive Gram stain for gram-positive cocci. You confirm a diagnosis of septic arthritis and prepare a management plan.

A 45-year-old woman presents with acute monoarthritis in her right ankle. She is febrile, and her joint aspirate reveals turbid fluid with neutrophilic predominance. Gram stain is inconclusive, but septic arthritis is suspected based on clinical findings. You begin planning treatment while awaiting cultures and sensitivities.

A 63-year-old man was treated for confirmed septic arthritis of the left shoulder two months ago. He received IV antibiotics and underwent surgical drainage. At review, he reports persistent pain, decreased range of motion, and muscle wasting. He asks about possible long-term consequences of his infection.

A 52-year-old woman is hospitalised with septic arthritis of the right knee caused by Staphylococcus aureus. She underwent joint aspiration and was started on IV antibiotics. While her acute symptoms have improved, she continues to have limited mobility and joint swelling. You are monitoring her recovery and considering potential complications that may affect long-term function.

A 70-year-old man with poorly controlled type 2 diabetes presents with septic arthritis of the left hip. He underwent urgent surgical washout and is now on IV antibiotics. Two weeks into treatment, his inflammatory markers have improved, but he remains immobile and requires assistance with daily activities. You are counselling him and his family about expected outcomes and long-term implications.

A 49-year-old woman with a history of rheumatoid arthritis presents with septic arthritis of the right shoulder. She had been on methotrexate and low-dose prednisone prior to infection. After surgical drainage and IV antibiotics, she has shown partial improvement but still has limited joint function. She asks about long-term expectations.

A 56-year-old male presents with sudden onset of pain, swelling, and erythema in his left knee. He is febrile, and the joint is warm with a moderate effusion. He denies trauma, and there’s no history of crystal arthropathy. Joint aspiration reveals turbid fluid. You are considering septic arthritis and aim to apply clinical and laboratory criteria to support the diagnosis.

A 47-year-old woman presents with fever, chills, and acute swelling of the right wrist. The joint is hot, red, and painful to move. Blood tests show elevated CRP and neutrophilia. Joint aspiration is underway. You aim to confirm septic arthritis based on accepted clinical and diagnostic findings.

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A 54-year-old man presents with a 2-day history of a hot, swollen, and painful right knee. He reports difficulty bearing weight and a subjective fever but has not measured his temperature. He denies trauma, travel, or recent illness. Past medical history includes hypertension and hyperlipidaemia. On examination, the joint is red, warm, and has limited active and passive range of motion. There is a moderate effusion. He is systemically well. Initial labs show a CRP of 76 and neutrophilic leukocytosis. Joint aspiration is pending.

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A 67-year-old woman with chronic kidney disease presents with acute pain and swelling in her left ankle. She reports that it began suddenly while walking and has progressively worsened. She feels feverish but hasn’t taken her temperature. Examination shows a warm, erythematous, swollen ankle with limited movement. There is mild pitting oedema of the foot. She has no prior history of inflammatory arthritis. Blood tests show WBC 13.4 x10⁹/L and CRP 98 mg/L. Septic arthritis is suspected, but the team is considering differentials before joint aspiration.

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A 55-year-old man presents with joint pain, swelling in both knees and wrists, and morning stiffness lasting more than 90 minutes. He reports recent fatigue and family history of autoimmune disease. Blood work shows elevated CRP and borderline positive RF. You suspect early rheumatoid arthritis and are discussing his background to identify modifiable and non-modifiable risk factors.

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A 41-year-old woman presents with a 4-month history of progressively worsening pain and stiffness in her hands and wrists, especially in the mornings. She reports that the stiffness lasts over an hour and is associated with joint swelling. On examination, she has tenderness and synovial thickening of multiple MCP and PIP joints bilaterally. Inflammatory markers are elevated. You suspect rheumatoid arthritis and are planning initial investigations to confirm the diagnosis and assess disease severity.

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A 52-year-old man presents with symmetrical swelling and morning stiffness affecting his wrists and metacarpophalangeal joints for over three months. He reports general fatigue and difficulty using his hands. Examination reveals synovitis in the wrists and tenderness of the MCP joints. You suspect early rheumatoid arthritis and aim to confirm the diagnosis and assess systemic involvement.

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A 38-year-old woman presents for review three months after a confirmed diagnosis of rheumatoid arthritis. She has ongoing joint pain, morning stiffness over an hour, and elevated inflammatory markers despite being started on NSAIDs and low-dose prednisone. Examination reveals active synovitis in her wrists and MCP joints. You are now discussing long-term disease-modifying options to manage her symptoms and prevent progression.

 

A 60-year-old man with established rheumatoid arthritis presents with worsening joint symptoms and morning stiffness lasting 90 minutes. He is currently on methotrexate 15 mg weekly and folic acid but has minimal improvement. He has no signs of infection and his LFTs are within normal range. He asks what can be done next to better control his symptoms and prevent joint damage.

A 59-year-old woman with seropositive rheumatoid arthritis presents with increasing fatigue, mild shortness of breath, and painful, swollen wrists and knees despite ongoing methotrexate and hydroxychloroquine. Examination reveals mild synovitis, crepitations at the lung bases, and mild anaemia on recent blood tests. She has no signs of active infection. You are reviewing her condition for possible complications related to long-standing RA.

A 66-year-old male with a 10-year history of rheumatoid arthritis presents with new-onset fatigue, early satiety, and easy bruising. He is on methotrexate and low-dose prednisone. On examination, he has palpable splenomegaly, petechiae on the lower limbs, and chronic deformities in his hands. His blood tests reveal neutropenia and mild thrombocytopenia. You are evaluating him for possible complications related to his underlying disease.

A 49-year-old woman with newly diagnosed seropositive rheumatoid arthritis asks about her long-term outlook. She currently has symmetrical swelling in the small joints of her hands and elevated inflammatory markers. She is anti-CCP and rheumatoid factor positive. Initial X-rays show no erosions. She wants to understand which factors may predict a more severe disease course or worse functional outcome.

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A 62-year-old man with established rheumatoid arthritis for over 10 years presents for routine review. He has moderate functional limitation and hand deformities despite consistent treatment. He is RF and anti-CCP positive. He reports chronic fatigue, mild shortness of breath, and recent weight loss. You are assessing factors that are known to predict worse long-term outcomes in RA.

A 45-year-old woman presents with a 4-month history of joint stiffness, especially in the mornings, lasting more than one hour. She reports swelling and pain in her wrists and fingers, particularly the MCP and PIP joints. She also notes fatigue and difficulty with handgrip tasks. Examination reveals bilateral wrist synovitis and tenderness of several MCP joints. Her ESR is elevated and she is awaiting rheumatology referral. You are reviewing the features that support a clinical diagnosis of rheumatoid arthritis.

A 58-year-old man presents with persistent joint pain and swelling in both hands, particularly in the MCP and PIP joints, for the past three months. He also experiences prolonged morning stiffness. Blood tests show elevated CRP and positive RF and anti-CCP antibodies. A hand X-ray reveals periarticular osteopenia. You aim to apply formal diagnostic criteria to support the diagnosis of rheumatoid arthritis.

A 52-year-old woman presents with a 6-month history of bilateral hand pain, morning stiffness lasting over an hour, and difficulty with tasks like opening jars and typing. Examination shows swelling and tenderness in the wrists, MCP, and PIP joints bilaterally. Inflammatory markers are mildly raised, and RF is negative. You are considering rheumatoid arthritis but want to explore other possible diagnoses before confirming.

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A 60-year-old man presents with bilateral wrist and finger pain for 5 months, with morning stiffness lasting over an hour. His hands feel swollen and weak, and he struggles with fine motor tasks. There are no skin lesions or systemic features. On exam, MCP and PIP joints are tender bilaterally with mild synovial thickening. Anti-CCP is negative and RF is equivocal. You are considering other causes of inflammatory polyarthritis.

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A 46-year-old woman presents with increasing tightness and stiffness in her fingers, particularly in cold weather. She also describes heartburn and difficulty swallowing solid foods. On examination, there is shiny skin over her hands, sclerodactyly, and digital pitting. She has no known autoimmune conditions in her family. ANA is positive, and she is being referred to rheumatology for suspected systemic sclerosis. You are considering potential risk factors that may have contributed to disease development.

A 51-year-old male construction worker presents with progressive fatigue, dry cough, and tightening of the skin over his chest and forearms. He also reports Raynaud’s phenomenon. Physical examination reveals thickened skin and telangiectasias. ANA is positive. He is concerned about what may have caused this condition and asks whether his work or lifestyle could be contributing factors.

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A 47-year-old woman presents with a 6-month history of Raynaud’s phenomenon, progressive skin tightening over the fingers, and heartburn. Examination reveals sclerodactyly, telangiectasia, and digital ulcers. Pulmonary auscultation reveals fine bibasal crackles. You suspect systemic sclerosis and want to request appropriate investigations to support the diagnosis and evaluate for organ involvement.

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A 56-year-old woman with diffuse cutaneous systemic sclerosis presents for review. She has progressive skin thickening, Raynaud’s phenomenon, and oesophageal dysmotility. Her high-resolution CT chest shows early interstitial lung disease. Pulmonary function tests show mildly reduced DLCO. She is ANA-positive and anti-Scl-70 positive. You are planning a comprehensive management approach to reduce disease progression and address symptoms.

A 61-year-old male with limited cutaneous systemic sclerosis presents for routine follow-up. He is known to have anti-centromere antibodies and has symptoms of mild Raynaud’s, telangiectasia, and dysphagia. He has no lung or renal involvement. However, he reports new exertional dyspnoea. You aim to prevent disease progression and assess for complications.

A 58-year-old woman with diffuse cutaneous systemic sclerosis presents with worsening fatigue and progressive breathlessness. She also reports difficulty swallowing and painful ulcers on her fingertips. On examination, there is digital pitting, sclerodactyly, and bibasal crackles. Her pulmonary function tests show a reduced DLCO, and her ANA and anti-Scl-70 antibodies are positive. You are assessing for complications related to her disease.

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A 62-year-old male with limited cutaneous systemic sclerosis presents with worsening exertional dyspnoea and lower extremity oedema. He has known anti-centromere antibodies and long-standing Raynaud’s phenomenon. Echocardiogram reveals elevated pulmonary artery pressure. He also reports dry eyes and mouth, as well as early satiety and bloating. You are evaluating systemic complications of his condition.

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A 49-year-old woman was diagnosed with diffuse cutaneous systemic sclerosis 18 months ago. She presents for review after recent pulmonary function testing revealed a decline in DLCO and FVC. She is ANA and anti-topoisomerase I (Scl-70) positive. She also has digital ulcers and progressive skin tightening. You are evaluating her prognosis and counselling her on factors that may indicate a more severe disease course.

A 63-year-old man with limited cutaneous systemic sclerosis is being reviewed for new-onset exertional dyspnoea. He has a 5-year history of Raynaud’s phenomenon and positive anti-centromere antibodies. His echocardiogram shows mild pulmonary hypertension, and PFTs are borderline. There is no interstitial lung disease on HRCT. You are evaluating prognostic factors to help guide his long-term management.

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A 54-year-old woman presents with a 1-year history of thickened skin over her fingers and forearms, along with Raynaud’s phenomenon. She also reports difficulty swallowing solids and intermittent reflux. On examination, there is clear sclerodactyly, pitted scars at the fingertips, and telangiectasias. ANA is positive, and pulmonary function tests show reduced DLCO. You are assessing whether her clinical picture fulfils the diagnostic criteria for systemic sclerosis.

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A 60-year-old man presents with progressive skin tightening of his hands and lower face, worsening reflux, and breathlessness on exertion. Examination reveals shiny, tight skin over the hands, loss of wrinkles around the mouth, and nailfold capillary dropout. He has a positive ANA with anti-Scl-70 antibodies. You are reviewing the classification features that contribute toward a systemic sclerosis diagnosis.

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A 50-year-old woman presents with progressive skin tightening over her hands and face, Raynaud’s phenomenon, and worsening dysphagia. She reports recent fatigue and shortness of breath. Examination reveals sclerodactyly, digital pitting scars, and telangiectasias. ANA and anti-Scl-70 antibodies are positive. Although systemic sclerosis is highly likely, you consider other conditions that could mimic this presentation.

A 61-year-old man presents with progressive tightening of the skin over his face and hands, chronic heartburn, and dyspnoea. He has a history of silica exposure from previous work in sandblasting. Examination reveals perioral tightening, reduced hand mobility, and fine bibasal crackles. You suspect systemic sclerosis, but you also consider other possible differentials.

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A 35-year-old man presents with a 6-month history of alternating low back pain and morning stiffness. He also reports intermittent episodes of diarrhoea, abdominal cramping, and weight loss. On examination, he has limited spinal flexion and tenderness over the sacroiliac joints. MRI shows bilateral sacroiliitis. Colonoscopy is pending. You are considering enteropathic arthritis and reviewing potential risk factors for developing this condition.

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A 42-year-old woman presents with chronic peripheral joint pain, fatigue, and episodes of bloody diarrhoea. She has a known history of ulcerative colitis diagnosed 3 years ago. Examination reveals swelling of her knees and ankles, with tenderness over the SI joints. You are reviewing her case for risk profiling of enteropathic arthritis.

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A 29-year-old man presents with lower back pain and stiffness for over six months, particularly worse in the mornings and after rest. He also reports intermittent episodes of diarrhoea and lower abdominal cramps. Examination reveals reduced lumbar flexion and tenderness over the sacroiliac joints. You suspect enteropathic arthritis associated with undiagnosed inflammatory bowel disease. You plan to investigate both his musculoskeletal and gastrointestinal symptoms.

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A 40-year-old woman with known ulcerative colitis presents with new-onset knee and ankle swelling and morning stiffness. She also reports fatigue and low back pain. Her bowel disease has been flaring over the past few months. Physical exam shows bilateral knee effusions and tenderness over the sacroiliac joints. You are planning investigations to evaluate the suspected enteropathic arthritis flare.

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A 33-year-old man with Crohn’s disease presents with persistent inflammatory back pain and stiffness for over a year. His symptoms improve with activity but worsen with rest. He has already been managed with mesalazine and short steroid courses for gut flares. On examination, there is reduced lumbar flexion and tenderness over the sacroiliac joints. MRI confirms bilateral sacroiliitis. He is ANA-negative and HLA-B27-positive. You are reviewing treatment options for his axial enteropathic arthritis.

A 46-year-old woman with ulcerative colitis presents with flares of knee, ankle, and wrist pain that correlate with worsening bowel symptoms. She has no spinal involvement. Examination shows active synovitis in both knees. Bloods show mildly elevated CRP. She is on mesalazine and azathioprine for her IBD. You are planning treatment for her peripheral enteropathic arthritis.

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A 36-year-old man with a 10-year history of Crohn’s disease presents with persistent sacroiliac pain and reduced lumbar flexibility. Despite good control of his bowel symptoms on adalimumab, he continues to experience progressive joint stiffness. Physical examination reveals restricted lumbar flexion and tenderness over the SI joints. MRI shows bilateral sacroiliitis with erosive changes. You are reviewing the long-term complications associated with enteropathic arthritis.

A 44-year-old woman with ulcerative colitis presents with increasing knee and ankle pain during a recent flare of her bowel symptoms. Over the past year, she has experienced multiple episodes of joint swelling that resolve within weeks but now reports worsening fatigue and lower back stiffness. Examination reveals peripheral joint effusions and limited spinal flexion. You are counselling her on possible complications if enteropathic arthritis is left uncontrolled.

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A 39-year-old man with Crohn’s disease presents with a 5-year history of back pain and morning stiffness. He has known HLA-B27 positivity and MRI-confirmed bilateral sacroiliitis. He is compliant with his IBD medications, including adalimumab, and reports partial symptom relief. Despite this, his spinal mobility continues to decline. You are discussing prognostic factors related to his axial enteropathic arthritis.

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A 46-year-old woman with ulcerative colitis has experienced episodic flares of joint pain affecting her knees and ankles. Her joint symptoms tend to coincide with bowel flare-ups and resolve within weeks. She has no axial involvement and no extra-articular features. You are counselling her on the likely prognosis based on her presentation and disease pattern.

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