# Rheumatology for NEET PG Medicine: Rheumatoid Arthritis, Spondyloarthritis, Gout, SLE, Systemic Sclerosis, Vasculitis Source: https://tracknation.in/story/rheumatology-for-neet-pg-medicine-rheumatoid-arthritis-spondyloarthritis-gout-sle-systemic-sclerosis-vasculitis (TrackNation — free UPSC notes with PYQs) > NEET PG Medicine: RA pattern, antibodies and methotrexate, osteoarthritis nodes, ankylosing spondylitis and HLA-B27, reactive and psoriatic arthritis, gout crystals, flares and urate target, septic arthritis, SLE antibodies and hydroxychloroquine, scleroderma renal crisis, GCA, Takayasu, PAN, GPA and IgA vasculitis, with a diagram, hooks, vignette MCQs and cards. ## Start Here 🎯 **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. | **Vasculitis (MSD)** | **Who / what** | **Clue** | **Treatment** | | Giant cell arteritis | Age 50 to > 90 (mean ~70) | Headache, scalp tenderness, jaw claudication, visual loss; PMR in 40–60% | Steroids at once; biopsy may follow | | Takayasu | Women 15–30 | Asymmetric pulses/BP, limb claudication | — | | Polyarteritis nodosa | ~20% have hepatitis B or C | Kidney, skin, nerves, gut; lungs spared | — | | GPA | c-ANCA (anti-PR3) | Sinusitis, epistaxis, saddle nose, lungs, kidneys | Steroids + rituximab or cyclophosphamide | | IgA vasculitis | Mostly children | Palpable purpura, arthralgia, GI symptoms, nephritis | — | ## 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 - Symmetric wrists/MCPs; spares DIP; stiffness > 60 min. - Swan-neck, boutonnière; atlantoaxial subluxation. - RF, anti-CCP. - 10–15 mg weekly + folic acid; max 25 mg. - Screen TB (PPD/IGRA), hepatitis B/C. - RA + splenomegaly + neutropenia. - Stiffness < 30 min; Heberden DIP, Bouchard PIP. - HLA-B27; sacroiliitis; uveitis; NSAIDs. - Chlamydia/Shigella; urethritis, conjunctivitis. - DIP, dactylitis, nails, mutilans. - Needle, negative birefringence. - NSAID, colchicine, steroid. - < 6 mg/dL. - Continue. - Positive birefringence; chondrocalcinosis. - S. aureus; drain. - Anti-dsDNA highly specific. - Hydroxychloroquine for all. - Congenital heart block. - ACE inhibitor. - > 50; jaw claudication; steroids now. - Women 15–30; unequal pulses. - Hep B/C ~20%; lungs spared. - c-ANCA/PR3; saddle nose. - 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 **Answer: (b)** — RA spares DIPs; stiffness > 60 minutes. **Q2.** The joints typically spared in rheumatoid arthritis are the - (a) knees - (b) wrists - (c) distal interphalangeal joints - (d) MCP joints **Answer: (c)** — OA and psoriatic arthritis involve DIPs. **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 **Answer: (b)** — Flexion–extension cervical radiographs. **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 **Answer: (d)** — Increase to 25 mg weekly if needed. **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 **Answer: (b)** — Reactivated TB is the main risk. **Q6.** An extra-articular manifestation of rheumatoid arthritis is - (a) tophi - (b) Felty syndrome - (c) dactylitis - (d) keratoderma blennorrhagicum **Answer: (b)** — Others: nodules (up to 30%), ILD, pericarditis, Sjögren, episcleritis. **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 **Answer: (d)** — Bouchard nodes are at PIPs. **Q8.** Morning stiffness in osteoarthritis typically lasts - (a) more than 2 hours - (b) over 60 minutes - (c) all day - (d) less than 30 minutes **Answer: (d)** — RA: > 60 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 **Answer: (c)** — Present in 90% of White patients with AS. **Q10.** First-line drug treatment of ankylosing spondylitis is - (a) methotrexate - (b) hydroxychloroquine - (c) allopurinol - (d) NSAIDs (then TNF or IL-17 inhibitors) **Answer: (d)** — Plus exercise and posture. **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 **Answer: (c)** — Chlamydia is most often implicated. **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 **Answer: (c)** — Dactylitis is not typical of RA. **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 **Answer: (b)** — Monosodium urate. **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 **Answer: (c)** — IL-1 inhibitors occasionally. **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 **Answer: (b)** — Adjust only after the flare settles. **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 **Answer: (c)** — Below the saturation point dissolves deposits. **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 **Answer: (a)** — Also reduced GFR and alcohol. **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 **Answer: (c)** — Chondrocalcinosis. **Q19.** The most common cause of acute septic arthritis is - (a) Staphylococcus aureus - (b) Neisseria gonorrhoeae in all ages - (c) Brucella - (d) Mycobacterium tuberculosis **Answer: (a)** — Treat with antibiotics and drainage. **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 **Answer: (a)** — Also anti-Sm. **Q21.** The drug recommended for all patients with SLE is - (a) allopurinol - (b) cyclophosphamide - (c) hydroxychloroquine - (d) methotrexate **Answer: (c)** — Steroids and immunosuppressants for organ involvement. **Q22.** A newborn has complete heart block. The mother most likely has antibodies to - (a) centromere - (b) Ro (SSA) - (c) PR3 - (d) dsDNA **Answer: (b)** — Less common with anti-La alone. **Q23.** Drug-induced lupus typically - (a) always involves the kidneys - (b) needs cyclophosphamide - (c) resolves after the drug is stopped - (d) is lifelong **Answer: (c)** — TNF inhibitors are among the causes. **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 **Answer: (a)** — Scleroderma renal crisis. **Q25.** Limited cutaneous systemic sclerosis is also called - (a) CREST syndrome - (b) mixed connective tissue disease - (c) Sjögren syndrome - (d) morphoea **Answer: (a)** — Anticentromere antibodies are typical. **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 **Answer: (a)** — Risk of blindness; biopsy remains positive for ~2 weeks. **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 **Answer: (a)** — Amaurosis fugax may precede permanent 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 **Answer: (d)** — Women aged 15–30; aorta and branches. **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 **Answer: (c)** — Kidneys, skin, nerves, gut. **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 **Answer: (d)** — Steroids + rituximab or cyclophosphamide. ### 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.