Question

Early-onset rheumatoid arthritis with a positive rheumatoid factor is more likely to have

• A. Self-limiting disease
• B. More persistent disease activity
• C. Less systemic involvement
• D. Distal interphalangeal joint involvement

Hint:

Think of rheumatoid factor as a marker of how aggressive the disease is likely to be, not of which joints it hits.

Answer 1

The Correct Option is B

Step 1: Understanding the Question:
The question asks what a positive rheumatoid factor at the onset of rheumatoid arthritis predicts about the disease course.

Step 2: Key Concept or Approach:
Rheumatoid factor positivity is one of the established markers of a more aggressive, erosive disease course in RA, alongside high antibody titers, anti-CCP positivity, and early joint erosions.

Step 3: Working Through the Options:
Seropositive, rheumatoid-factor-positive early RA correlates with more persistent, harder-to-control disease activity, greater joint damage and a higher likelihood of extra-articular manifestations compared with seronegative disease. It is not associated with a self-limiting course, since that pattern is more typical of some seronegative or reactive arthritides. It does not predict less systemic involvement either; if anything, seropositive disease carries a higher risk of systemic and extra-articular features such as rheumatoid nodules, vasculitis and lung disease. Distal interphalangeal joint involvement is atypical for RA altogether, since that pattern points toward osteoarthritis or psoriatic arthritis instead, and rheumatoid factor status does not specifically drive DIP involvement.

Step 4: Conclusion:
A positive rheumatoid factor early in RA predicts more persistent disease activity, so that is correct.