Rheumatoid arthritis MCQs With Answer

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Rheumatoid arthritis MCQs With Answer provide B. Pharm students an essential, exam-focused review of rheumatoid arthritis (RA) pharmacotherapy, pathophysiology, diagnosis, and monitoring. This concise, keyword-rich introduction covers RA basics, immunologic mechanisms, disease-modifying antirheumatic drugs (DMARDs), biologics, JAK inhibitors, NSAIDs, corticosteroids, adverse effects, therapeutic monitoring, and important drug interactions. Designed for pharmacy undergraduates, these practice questions emphasize clinical decision-making, dose adjustments, laboratory monitoring (RF, anti-CCP, ESR, CRP), and patient counseling points. Strengthen your understanding of RA management and drug safety while preparing for university exams and competitive tests. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which autoantibody is most specific for diagnosing rheumatoid arthritis?

  • Rheumatoid factor (RF)
  • Anti-cyclic citrullinated peptide (anti-CCP)
  • Anti-dsDNA
  • Anti-histone antibody

Correct Answer: Anti-cyclic citrullinated peptide (anti-CCP)

Q2. The primary mechanism of methotrexate in RA is:

  • Inhibition of TNF-alpha
  • Folate antagonism leading to anti-inflammatory effects
  • Blocking COX enzymes
  • IL-6 receptor antagonism

Correct Answer: Folate antagonism leading to anti-inflammatory effects

Q3. Which drug class is considered conventional synthetic DMARDs?

  • TNF inhibitors
  • JAK inhibitors
  • Methotrexate and sulfasalazine
  • IL-6 receptor antagonists

Correct Answer: Methotrexate and sulfasalazine

Q4. Which laboratory marker is used to monitor inflammation in RA?

  • Serum creatinine
  • CRP (C-reactive protein)
  • Fasting glucose
  • Serum bilirubin

Correct Answer: CRP (C-reactive protein)

Q5. A common initial adverse effect of methotrexate is:

  • Renal failure
  • Mucositis and hepatotoxicity
  • Hyperglycemia
  • Cardiac arrhythmia

Correct Answer: Mucositis and hepatotoxicity

Q6. Which biologic targets tumor necrosis factor-alpha (TNF-α)?

  • Etanercept
  • Tocilizumab
  • Abatacept
  • Rituximab

Correct Answer: Etanercept

Q7. Which medication class increases risk of serious infections in RA patients?

  • NSAIDs
  • Biologic DMARDs
  • Calcium supplements
  • Topical analgesics

Correct Answer: Biologic DMARDs

Q8. Anti-CCP positivity correlates with:

  • Lower disease severity
  • Higher likelihood of erosive disease
  • Exclusive involvement of large joints
  • Resistance to all DMARDs

Correct Answer: Higher likelihood of erosive disease

Q9. Which drug is an oral JAK inhibitor used in RA?

  • Infliximab
  • Tofacitinib
  • Sulfasalazine
  • Hydroxychloroquine

Correct Answer: Tofacitinib

Q10. Which radiographic finding is characteristic of advanced RA?

  • Osteophyte formation
  • Joint space narrowing and marginal erosions
  • Calcification of ligaments
  • Subchondral sclerosis without erosions

Correct Answer: Joint space narrowing and marginal erosions

Q11. Low-dose corticosteroids in RA are mainly used for:

  • Curative therapy
  • Short-term bridge therapy to control flares
  • Preventing infections
  • Long-term monotherapy

Correct Answer: Short-term bridge therapy to control flares

Q12. Which vaccine is recommended before starting biologic therapy?

  • Live attenuated varicella vaccine during therapy
  • Inactivated influenza and pneumococcal vaccines prior to therapy
  • Oral polio vaccine
  • Live MMR vaccine during therapy

Correct Answer: Inactivated influenza and pneumococcal vaccines prior to therapy

Q13. Which adverse effect is associated with hydroxychloroquine?

  • Retinopathy with long-term use
  • Ototoxicity
  • Severe nephrotoxicity
  • Hyperthyroidism

Correct Answer: Retinopathy with long-term use

Q14. Which DMARD is contraindicated in pregnancy?

  • Sulfasalazine
  • Hydroxychloroquine
  • Methotrexate
  • Azathioprine

Correct Answer: Methotrexate

Q15. Rituximab exerts its effect by targeting which cell type?

  • T lymphocytes
  • B lymphocytes (CD20)
  • Neutrophils
  • Synovial fibroblasts

Correct Answer: B lymphocytes (CD20)

Q16. The 2010 ACR/EULAR classification criteria for RA emphasize:

  • Only radiographic changes
  • Joint involvement, serology, acute-phase reactants, and symptom duration
  • Presence of skin rash
  • Urinary biomarkers only

Correct Answer: Joint involvement, serology, acute-phase reactants, and symptom duration

Q17. Which NSAID adverse effect is most concerning in chronic use?

  • Gastrointestinal bleeding and peptic ulcers
  • Hair loss
  • Increased tooth decay
  • Excessive salivation

Correct Answer: Gastrointestinal bleeding and peptic ulcers

Q18. Which monitoring test is essential before and during methotrexate therapy?

  • Serum potassium
  • Liver function tests and CBC
  • Serum amylase only
  • Thyroid function tests

Correct Answer: Liver function tests and CBC

Q19. Which drug combination is commonly used for initial RA management?

  • Methotrexate plus folic acid
  • Methotrexate plus high-dose folic acid to achieve immunosuppression
  • Only NSAIDs indefinitely
  • Antibiotics plus antivirals

Correct Answer: Methotrexate plus folic acid

Q20. Which statement about TNF inhibitors is correct?

  • They are small-molecule oral agents.
  • They increase risk of reactivation of latent tuberculosis.
  • They have no immunosuppressive effects.
  • They are contraindicated in all infections regardless of severity.

Correct Answer: They increase risk of reactivation of latent tuberculosis.

Q21. Sulfasalazine’s therapeutic benefit in RA is partly due to:

  • Direct COX-2 inhibition exclusively
  • Anti-inflammatory and immunomodulatory effects after colonic activation
  • Inhibition of renin-angiotensin system
  • Increased bone formation

Correct Answer: Anti-inflammatory and immunomodulatory effects after colonic activation

Q22. Early aggressive treatment of RA aims to:

  • Delay therapy until radiographic damage appears
  • Prevent joint damage and achieve remission
  • Rely solely on surgery for joint replacement
  • Use only topical agents

Correct Answer: Prevent joint damage and achieve remission

Q23. Which adverse effect is particularly associated with leflunomide?

  • Pulmonary fibrosis and hepatotoxicity
  • Severe hypoglycemia
  • Acute pancreatitis
  • Peripheral neuropathy exclusively

Correct Answer: Pulmonary fibrosis and hepatotoxicity

Q24. Which is a biosimilar concept relevant to biologics in RA?

  • Identical chemical structure to original biologic
  • Similar efficacy and safety to originator after comparability studies
  • Generic small-molecule version
  • Completely different mechanism of action

Correct Answer: Similar efficacy and safety to originator after comparability studies

Q25. Which is true about anti-TNF therapy and vaccination?

  • Live vaccines should be given while on anti-TNF therapy
  • Ideally give required live vaccines before starting anti-TNF therapy
  • Vaccination status is irrelevant
  • All vaccines are contraindicated permanently

Correct Answer: Ideally give required live vaccines before starting anti-TNF therapy

Q26. Which clinical feature is typical of RA but not osteoarthritis?

  • Pain worse with use and improves with rest
  • Morning stiffness lasting more than 30 minutes
  • Asymmetric joint involvement
  • Heberden’s nodes exclusively

Correct Answer: Morning stiffness lasting more than 30 minutes

Q27. What is a common drug interaction concern with methotrexate?

  • Increased toxicity with trimethoprim-sulfamethoxazole
  • Complete inactivation by atorvastatin
  • Reduced methotrexate levels with NSAIDs
  • Enhanced methotrexate clearance with proton pump inhibitors

Correct Answer: Increased toxicity with trimethoprim-sulfamethoxazole

Q28. Which cell type plays a central role in RA synovial inflammation?

  • Neurons
  • Synovial fibroblasts and infiltrating immune cells (T and B cells)
  • Osteocytes only
  • Hepatocytes

Correct Answer: Synovial fibroblasts and infiltrating immune cells (T and B cells)

Q29. In RA, low-dose aspirin as an NSAID alternative is limited because it:

  • Has no anti-inflammatory effects
  • Increases gastrointestinal bleeding risk and may be less effective for inflammation
  • Causes immediate joint healing
  • Is a DMARD

Correct Answer: Increases gastrointestinal bleeding risk and may be less effective for inflammation

Q30. Which monitoring parameter is important when a patient is on tocilizumab?

  • Serum lipids and liver enzymes
  • Urine culture weekly
  • Serial ECGs monthly
  • Bone density every week

Correct Answer: Serum lipids and liver enzymes

Q31. Which therapy is indicated for RA patients refractory to TNF inhibitors?

  • Increase NSAIDs only
  • Switch to another biologic with different mechanism (e.g., rituximab, tocilizumab, abatacept)
  • Discontinue all DMARDs
  • Use topical creams alone

Correct Answer: Switch to another biologic with different mechanism (e.g., rituximab, tocilizumab, abatacept)

Q32. Which test indicates active synovial inflammation in RA?

  • Low ESR and CRP
  • Elevated ESR and CRP
  • Normal anti-CCP
  • Decreased white blood cell count

Correct Answer: Elevated ESR and CRP

Q33. Abatacept modulates immune response by:

  • Depleting B cells
  • Blocking T-cell costimulation (CTLA-4 Ig)
  • Inhibiting JAK enzymes
  • Neutralizing IL-1

Correct Answer: Blocking T-cell costimulation (CTLA-4 Ig)

Q34. Which is a non-pharmacologic recommendation for RA patients?

  • Smoking cessation and regular physiotherapy
  • Complete immobilization of joints forever
  • Only bed rest without exercise
  • Avoid all protein in diet

Correct Answer: Smoking cessation and regular physiotherapy

Q35. Which laboratory abnormality suggests methotrexate toxicity?

  • Elevated hemoglobin
  • Leucopenia and thrombocytopenia
  • Hypernatremia
  • Decreased uric acid only

Correct Answer: Leucopenia and thrombocytopenia

Q36. Which agent can be used to reverse methotrexate toxicity?

  • Naloxone
  • Folinic acid (leucovorin)
  • Vitamin B12 only
  • Insulin

Correct Answer: Folinic acid (leucovorin)

Q37. Which characteristic differentiates seropositive RA from seronegative RA?

  • Presence of RF or anti-CCP antibodies in seropositive RA
  • Seropositive RA always resolves without treatment
  • Seronegative RA always involves skin rash
  • Only seronegative RA causes erosions

Correct Answer: Presence of RF or anti-CCP antibodies in seropositive RA

Q38. Which adverse effect is associated with long-term corticosteroid use?

  • Osteoporosis, hyperglycemia, and hypertension
  • Improved bone density
  • Permanent weight loss
  • Enhanced immune response to vaccines

Correct Answer: Osteoporosis, hyperglycemia, and hypertension

Q39. Which statement about NSAIDs in RA is correct?

  • NSAIDs cure rheumatoid arthritis
  • NSAIDs provide symptomatic relief of pain and inflammation but do not prevent disease progression
  • NSAIDs are the only recommended long-term therapy
  • NSAIDs have no GI risks

Correct Answer: NSAIDs provide symptomatic relief of pain and inflammation but do not prevent disease progression

Q40. Which DMARD has anti-malarial origin and immunomodulatory properties?

  • Hydroxychloroquine
  • Methotrexate
  • Leflunomide
  • Cyclosporine

Correct Answer: Hydroxychloroquine

Q41. What is the role of folic acid in patients taking methotrexate?

  • Enhances methotrexate’s antirheumatic effect by increasing toxicity
  • Reduces methotrexate-related mucosal and hematologic toxicity
  • Converts methotrexate to an inactive metabolite
  • Is contraindicated with methotrexate

Correct Answer: Reduces methotrexate-related mucosal and hematologic toxicity

Q42. Which adverse effect requires regular ophthalmic monitoring with hydroxychloroquine?

  • Cardiomyopathy
  • Retinal toxicity causing vision changes
  • Hearing loss
  • Renal stones

Correct Answer: Retinal toxicity causing vision changes

Q43. Which agent is recommended for RA patients with severe nodulizing disease where methotrexate may worsen nodules?

  • Methotrexate dose escalation
  • Switch to leflunomide or biologic options
  • High-dose aspirin alone
  • Topical methotrexate

Correct Answer: Switch to leflunomide or biologic options

Q44. Which immunization should be avoided while a patient is receiving biologic immunosuppressants?

  • Inactivated influenza vaccine
  • Live attenuated vaccines (e.g., live zoster)
  • Pneumococcal polysaccharide vaccine
  • Hepatitis B inactivated vaccine

Correct Answer: Live attenuated vaccines (e.g., live zoster)

Q45. Which is an early sign of rheumatoid arthritis in peripheral joints?

  • Symmetric small joint swelling of the hands and wrists
  • Isolated unilateral hip pain only
  • Exclusive spinal involvement
  • Rapid bone tumor formation

Correct Answer: Symmetric small joint swelling of the hands and wrists

Q46. Which biomarker is more predictive of erosive disease and worse prognosis?

  • Low CRP
  • High anti-CCP antibody titers
  • Normal ESR
  • Low RF titer

Correct Answer: High anti-CCP antibody titers

Q47. Which pharmacologic property is true for biologic DMARDs?

  • They are typically small molecules given orally
  • They are large protein molecules administered parenterally
  • They have no immunogenic potential
  • They require renal dose adjustment only

Correct Answer: They are large protein molecules administered parenterally

Q48. Which counseling point is important for patients starting methotrexate?

  • Continue high-dose alcohol consumption
  • Avoid pregnancy and use effective contraception
  • No need for laboratory monitoring
  • Stop folic acid supplementation

Correct Answer: Avoid pregnancy and use effective contraception

Q49. Which agent is most appropriate for rapid short-term control of severe RA flare?

  • High-dose long-term methotrexate only
  • Systemic corticosteroids for short-term use
  • Topical NSAIDs only
  • Hydroxychloroquine alone immediately

Correct Answer: Systemic corticosteroids for short-term use

Q50. Which sign on physical exam suggests active synovitis in RA?

  • Warmth, swelling, and tenderness of the joint
  • Cool, dry skin over the joint without swelling
  • Isolated muscle weakness without joint findings
  • Only crepitus without swelling

Correct Answer: Warmth, swelling, and tenderness of the joint

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