Question:
Which of the following is a poor prognostic factor in rheumatoid arthritis?
Which of the following is a poor prognostic factor in rheumatoid arthritis?
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When evaluating Rheumatoid Arthritis, the presence of Anti-CCP antibodies is not only highly specific for diagnosis but is also one of the strongest independent predictors of aggressive, erosive joint damage. Treat seropositive patients early and aggressively.
Updated On: Sep 3, 2026
- Presence of joint erosions on X-ray
- Rheumatoid factor positivity
- anti -CCP positivity
- Early methotrexate usage
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The Correct Option is D
Solution and Explanation
Concept:
This question asks to identify the odd one out regarding the prognostic factors in Rheumatoid Arthritis (RA). Poor prognostic factors imply a higher likelihood of rapidly progressive, erosive disease with severe functional decline.
Explanation:
• Established poor prognostic factors in RA that predict a more aggressive disease course include:
1. High titers of Rheumatoid Factor (RF) and Anti-Cyclic Citrullinated Peptide (anti-CCP) antibodies.
2. Early presence of joint erosions on radiographs.
3. High acute phase reactants (persistently elevated ESR or CRP).
4. Presence of extra-articular manifestations (e.g., rheumatoid nodules, vasculitis).
5. High degree of functional disability at baseline.
• Option (A) is a poor prognostic factor, indicating aggressive bone destruction is already underway.
• Option (B) and Option (C) are poor prognostic factors; seropositive patients tend to have more severe, erosive disease and are at higher risk for extra-articular manifestations compared to seronegative patients.
• Option (D), Early methotrexate usage, is the cornerstone of modern RA management. Initiating a Disease-Modifying Antirheumatic Drug (DMARD) early in the disease course (within the "window of opportunity") suppresses inflammation, halts radiographic progression, and drastically improves the prognosis. Therefore, it is a good prognostic indicator, making it the exception among the choices.
Final answer:
While the question text lacks the word "NOT", early methotrexate usage is the only factor listed that prevents disease progression, contrasting with the other three universally accepted poor prognostic markers.
This question asks to identify the odd one out regarding the prognostic factors in Rheumatoid Arthritis (RA). Poor prognostic factors imply a higher likelihood of rapidly progressive, erosive disease with severe functional decline.
Explanation:
• Established poor prognostic factors in RA that predict a more aggressive disease course include:
1. High titers of Rheumatoid Factor (RF) and Anti-Cyclic Citrullinated Peptide (anti-CCP) antibodies.
2. Early presence of joint erosions on radiographs.
3. High acute phase reactants (persistently elevated ESR or CRP).
4. Presence of extra-articular manifestations (e.g., rheumatoid nodules, vasculitis).
5. High degree of functional disability at baseline.
• Option (A) is a poor prognostic factor, indicating aggressive bone destruction is already underway.
• Option (B) and Option (C) are poor prognostic factors; seropositive patients tend to have more severe, erosive disease and are at higher risk for extra-articular manifestations compared to seronegative patients.
• Option (D), Early methotrexate usage, is the cornerstone of modern RA management. Initiating a Disease-Modifying Antirheumatic Drug (DMARD) early in the disease course (within the "window of opportunity") suppresses inflammation, halts radiographic progression, and drastically improves the prognosis. Therefore, it is a good prognostic indicator, making it the exception among the choices.
Final answer:
While the question text lacks the word "NOT", early methotrexate usage is the only factor listed that prevents disease progression, contrasting with the other three universally accepted poor prognostic markers.
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