Rheumatology for NEET PG Medicine: Rheumatoid Arthritis, Spondyloarthritis, Gout, SLE, Systemic Sclerosis, Vasculitis

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🎯 Exam priority: High. Expect: RA vs OA vs psoriatic patterns, morning stiffness, deformities, atlantoaxial risk, methotrexate dose and TB screening before biologics, HLA-B27 and sacroiliitis, reactive arthritis triad, gout crystals and urate target, septic arthritis organism, SLE antibodies, anti-Ro and heart block, scleroderma renal crisis and ACE inhibitor, GCA urgency, Takayasu, PAN–hepatitis B, GPA c-ANCA, IgA vasculitis.

CBME mapping: GM 7.1–7.22. Immunopathology is in Pathology; DMARD pharmacology in Pharmacology; orthopaedic joint surgery in Orthopaedics.

Arthritis patterns, gout, SLE and scleroderma, vasculitis. Drawn by TrackNation.

Rheumatoid and Osteoarthritis

• RA: symmetric inflammation of peripheral joints (wrists, MCPs) — almost any joint except the DIPs; morning stiffness > 60 minutes; swan-neck and boutonnière deformities; carpal tunnel; cervical atlantoaxial subluxation. Extra-articular: nodules, ILD, pericarditis, Felty syndrome, Sjögren, episcleritis; subcutaneous nodules in up to 30%. RF and anti-CCP (RF is also low-titre positive in 3% of people and 20% of the elderly).

• Treatment: methotrexate 10–15 mg once weekly with daily folic acid, increased to 25 mg; benefit within ~6 weeks. Add a biologic if inadequate, or use triple therapy (methotrexate + hydroxychloroquine + sulfasalazine). Screen for TB (PPD or IGRA) and hepatitis B/C before biologics.

• Osteoarthritis: activity-related pain, stiffness < 30 minutes; Heberden (DIP) and Bouchard (PIP) nodes; thumb CMC; osteophytes and sclerosis on X-ray. Education, weight loss, joint protection, topical/oral NSAIDs.

Spondyloarthritis, Crystals and Septic Joints

• Ankylosing spondylitis: HLA-B27 in 90% (of White patients; also up to 10% of the population); sacroiliitis on imaging; anterior uveitis, aortitis, conduction defects; late bamboo spine. NSAIDs, TNF or IL-17 inhibitors, exercise.

• Reactive arthritis: after Chlamydia (genital) or Shigella/Salmonella (enteric) infection; urethritis or cervicitis, conjunctivitis, keratoderma blennorrhagicum.

• Psoriatic arthritis: asymmetric, DIP joints, dactylitis, nail disease, arthritis mutilans (telescoping digits).

• Gout: first MTP flare; needle-shaped, negatively birefringent urate crystals; tophi. Flares: NSAIDs, colchicine or glucocorticoids. Long term: allopurinol, febuxostat or probenecid to urate < 6 mg/dL. Continue urate-lowering therapy during a flare — MSD states there is no contraindication to starting it during a flare. Thiazide and loop diuretics raise urate.

• CPPD: positively birefringent crystals; chondrocalcinosis of the knee.

• Septic arthritis: S. aureus commonest; gonococcus in sexually active young people; antibiotics plus joint drainage.

SLE, Systemic Sclerosis, Vasculitis

• SLE: arthritis, Raynaud, malar rash, serositis, nephritis, CNS disease, cytopenias. ANA screen; anti-dsDNA is highly specific; anti-Sm, anti-Ro/La, C3/C4. Hydroxychloroquine for all patients. Anti-Ro in a mother → congenital heart block. Drug-induced lupus resolves when the drug stops.

• Systemic sclerosis: Raynaud, dysphagia, heartburn, finger skin thickening. Limited (CREST) vs diffuse. Anti-Scl-70, anticentromere. ILD and renal crisis are the major complications — renal crisis needs an ACE inhibitor promptly.

Traps the Examiner Sets

• RA spares DIPs; OA and psoriatic arthritis involve them.

• Methotrexate is weekly, not daily.

• Gout: negative needles; CPPD: positive rhomboid-type crystals.

• Suspected GCA: steroids first — do not wait for biopsy.

• Scleroderma renal crisis: ACE inhibitor.

Memory Hooks & Shortcuts

Shortcuts to lock in this article's numbers and lists. Each one only re-packages facts proven above.

• 🧠 RA 'Rarely At DIP'; OA and Psoriatic 'Down In the DIP' — DIP involvement

• 🧠 Methotrexate: 'Monday only' — once weekly — methotrexate

• 🧠 Gout 'Negative Needles'; CPPD 'Positive Pyrophosphate' — crystals

• 🧠 Reactive arthritis: 'Can't see, can't pee, can't climb a tree' — reactive arthritis

• 🧠 GCA: 'Steroids before scalpel' — GCA

• 🧠 Scleroderma kidney: 'ACE saves the kidney' — renal crisis

Rapid-Revision Cards

• RA pattern

  Symmetric wrists/MCPs; spares DIP; stiffness > 60 min.

• RA deformities

  Swan-neck, boutonnière; atlantoaxial subluxation.

• RA antibodies

  RF, anti-CCP.

• Methotrexate

  10–15 mg weekly + folic acid; max 25 mg.

• Before biologics

  Screen TB (PPD/IGRA), hepatitis B/C.

• Felty

  RA + splenomegaly + neutropenia.

• OA

  Stiffness < 30 min; Heberden DIP, Bouchard PIP.

• AS

  HLA-B27; sacroiliitis; uveitis; NSAIDs.

• Reactive arthritis

  Chlamydia/Shigella; urethritis, conjunctivitis.

• Psoriatic

  DIP, dactylitis, nails, mutilans.

• Gout crystals

  Needle, negative birefringence.

• Gout flare Rx

  NSAID, colchicine, steroid.

• Urate target

  < 6 mg/dL.

• ULT in flare

  Continue.

• CPPD

  Positive birefringence; chondrocalcinosis.

• Septic arthritis

  S. aureus; drain.

• SLE antibody

  Anti-dsDNA highly specific.

• SLE drug

  Hydroxychloroquine for all.

• Anti-Ro

  Congenital heart block.

• SSc renal crisis

  ACE inhibitor.

• GCA

  > 50; jaw claudication; steroids now.

• Takayasu

  Women 15–30; unequal pulses.

• PAN

  Hep B/C ~20%; lungs spared.

• GPA

  c-ANCA/PR3; saddle nose.

• IgA vasculitis

  Children; palpable purpura.

Sources

Facts in this article were checked against these documents.

• MSD Manual Professional: Rheumatoid Arthritis; Osteoarthritis; Ankylosing Spondylitis; Reactive Arthritis; Psoriatic Arthritis; Gout; CPPD; Acute Infectious Arthritis; SLE; Systemic Sclerosis; Giant Cell Arteritis; Takayasu Arteritis; Polyarteritis Nodosa; GPA; IgA Vasculitis — Merck & Co. (MSD Manuals), reviewed 2025–26 (link)

• Competency Based Undergraduate Curriculum, General Medicine (GM 7) — National Medical Commission, 2024

Test Yourself: Practice Questions

Thirty questions in NEET PG style, most of them clinical vignettes.

Practice Questions (NEET PG pattern)

Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.

Q1. A woman has symmetric pain and swelling of wrists and MCP joints with morning stiffness lasting over an hour; DIP joints are normal. The likely diagnosis is

• (a) gout

• (b) rheumatoid arthritis

• (c) psoriatic arthritis

• (d) osteoarthritis

Q2. The joints typically spared in rheumatoid arthritis are the

• (a) knees

• (b) wrists

• (c) distal interphalangeal joints

• (d) MCP joints

Q3. A patient with long-standing destructive RA develops occipital headache and hyperreflexia. The cervical complication to look for is

• (a) lumbar disc prolapse

• (b) atlantoaxial subluxation

• (c) temporomandibular ankylosis only

• (d) sacroiliitis

Q4. The usual starting dose of methotrexate in rheumatoid arthritis is

• (a) 2.5 mg monthly

• (b) 50 mg weekly

• (c) 10 mg daily

• (d) 10–15 mg once a week with daily folic acid

Q5. Before starting a TNF inhibitor for RA, the patient must be screened for

• (a) G6PD

• (b) latent tuberculosis (PPD or IGRA) and hepatitis B/C

• (c) HLA-B27

• (d) anti-dsDNA

Q6. An extra-articular manifestation of rheumatoid arthritis is

• (a) tophi

• (b) Felty syndrome

• (c) dactylitis

• (d) keratoderma blennorrhagicum

Q7. Bony swellings of the DIP joints in a patient with activity-related hand pain and brief morning stiffness are

• (a) Bouchard nodes

• (b) rheumatoid nodules

• (c) tophi

• (d) Heberden nodes of osteoarthritis

Q8. Morning stiffness in osteoarthritis typically lasts

• (a) more than 2 hours

• (b) over 60 minutes

• (c) all day

• (d) less than 30 minutes

Q9. A young man has inflammatory low back pain and an episode of anterior uveitis; MRI shows sacroiliitis. The associated HLA is

• (a) HLA-DR4

• (b) HLA-B5701

• (c) HLA-B27

• (d) HLA-DQ2

Q10. First-line drug treatment of ankylosing spondylitis is

• (a) methotrexate

• (b) hydroxychloroquine

• (c) allopurinol

• (d) NSAIDs (then TNF or IL-17 inhibitors)

Q11. After a sexually acquired infection, a man develops arthritis, urethritis, conjunctivitis and hyperkeratotic crusted skin lesions. The diagnosis is

• (a) psoriatic arthritis

• (b) gonococcal arthritis

• (c) reactive arthritis (keratoderma blennorrhagicum)

• (d) gout

Q12. A patient with psoriasis has a 'sausage' swollen finger and DIP joint arthritis with nail changes. This is

• (a) septic arthritis

• (b) rheumatoid arthritis

• (c) psoriatic arthritis

• (d) osteoarthritis

Q13. A man wakes with an exquisitely painful, red, swollen first MTP joint. Synovial fluid shows needle-shaped, negatively birefringent crystals. The diagnosis is

• (a) pseudogout (CPPD)

• (b) gout

• (c) septic arthritis

• (d) reactive arthritis

Q14. Drugs used to treat an acute gout flare include

• (a) aspirin

• (b) allopurinol alone at high dose

• (c) NSAIDs, colchicine or glucocorticoids

• (d) probenecid only

Q15. A patient already on allopurinol develops a gout flare. The allopurinol should be

• (a) switched to probenecid

• (b) continued at the same dose

• (c) stopped

• (d) doubled

Q16. The usual serum urate target on long-term urate-lowering therapy is

• (a) < 2 mg/dL

• (b) < 8.5 mg/dL

• (c) < 6 mg/dL

• (d) < 10 mg/dL

Q17. A drug class that raises serum urate and can provoke gout is

• (a) thiazide and loop diuretics

• (b) statins

• (c) calcium-channel blockers

• (d) ACE inhibitors

Q18. An elderly patient has acute knee arthritis; X-ray shows cartilage calcification and fluid shows positively birefringent crystals. The diagnosis is

• (a) osteoarthritis only

• (b) septic arthritis

• (c) calcium pyrophosphate deposition disease

• (d) gout

Q19. The most common cause of acute septic arthritis is

• (a) Staphylococcus aureus

• (b) Neisseria gonorrhoeae in all ages

• (c) Brucella

• (d) Mycobacterium tuberculosis

Q20. A young woman has a malar rash, arthritis, pleuritic pain and proteinuria; ANA is positive. The antibody most specific for SLE is

• (a) anti-dsDNA

• (b) rheumatoid factor

• (c) anti-histone

• (d) ANA

Q21. The drug recommended for all patients with SLE is

• (a) allopurinol

• (b) cyclophosphamide

• (c) hydroxychloroquine

• (d) methotrexate

Q22. A newborn has complete heart block. The mother most likely has antibodies to

• (a) centromere

• (b) Ro (SSA)

• (c) PR3

• (d) dsDNA

Q23. Drug-induced lupus typically

• (a) always involves the kidneys

• (b) needs cyclophosphamide

• (c) resolves after the drug is stopped

• (d) is lifelong

Q24. A patient with diffuse systemic sclerosis develops scleroderma renal crisis. The treatment is

• (a) an ACE inhibitor promptly

• (b) high-dose steroids

• (c) beta-blocker only

• (d) dialysis without drugs

Q25. Limited cutaneous systemic sclerosis is also called

• (a) CREST syndrome

• (b) mixed connective tissue disease

• (c) Sjögren syndrome

• (d) morphoea

Q26. A 72-year-old has new headache, temporal artery tenderness and jaw pain on chewing; ESR is high. The next step is

• (a) start corticosteroids immediately, then arrange temporal artery biopsy

• (b) start aspirin only

• (c) MRI brain first and observe

• (d) wait for biopsy before treatment

Q27. In giant cell arteritis, features that carry a higher risk of blindness are

• (a) jaw claudication and diplopia

• (b) raised platelets

• (c) shoulder stiffness

• (d) fever and weight loss

Q28. A 24-year-old woman has arm claudication and a 30 mm Hg difference in systolic BP between arms. The likely diagnosis is

• (a) coarctation in all cases

• (b) giant cell arteritis

• (c) PAN

• (d) Takayasu arteritis

Q29. Polyarteritis nodosa is associated with hepatitis B or C in about

• (a) 90%, with lung cavities

• (b) 50% with sinusitis

• (c) 20% of patients, and typically spares the lungs

• (d) none

Q30. A patient has chronic bloody nasal discharge, saddle-nose deformity, lung involvement and haematuria; c-ANCA (anti-PR3) is positive. The diagnosis is

• (a) SLE

• (b) Churg–Strauss only

• (c) PAN

• (d) granulomatosis with polyangiitis

Active Recall

From memory: contrast RA, OA and psoriatic arthritis, give methotrexate dosing and pre-biologic screening, describe ankylosing spondylitis and reactive arthritis, gout crystals, flare and long-term treatment, septic arthritis, SLE antibodies and treatment, scleroderma renal crisis, and the key features of GCA, Takayasu, PAN, GPA and IgA vasculitis.