Immunopathology: rheumatoid arthritis: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Immunopathology: rheumatoid arthritis

Sample item

A 45-year-old woman has symmetrical swelling of the metacarpophalangeal and proximal interphalangeal joints with morning stiffness lasting 2 hours. Which finding is the most specific serological marker for her likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Anti-cyclic citrullinated peptide antibody

Anti-CCP antibodies are about 95% specific for rheumatoid arthritis and may precede clinical disease; they predict erosive course. Rheumatoid factor is more sensitive but less specific, being found in hepatitis C, endocarditis and ageing. Histology shows pannus formation by synovial hyperplasia with chronic inflammation.

Option by option

  • A. Anti-Jo-1 antibody

    Anti-Jo-1 is linked to polymyositis with interstitial lung disease.

  • B. Antinuclear antibody

    ANA is a screening test for lupus and is non-specific here.

  • C. Anti-cyclic citrullinated peptide antibody (correct)

    Antibodies to citrullinated peptides are the most specific serological marker of rheumatoid arthritis.

  • D. Rheumatoid factor

    Rheumatoid factor is sensitive but also positive in other chronic infections and diseases.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Anti-cyclic citrullinated peptide antibody. Anti-CCP antibodies are about 95% specific for rheumatoid arthritis and may precede clinical disease; they predict erosive course.

Why is "Anti-Jo-1 antibody" not the answer?

Anti-Jo-1 is linked to polymyositis with interstitial lung disease.

Why is "Antinuclear antibody" not the answer?

ANA is a screening test for lupus and is non-specific here.

Why is "Rheumatoid factor" not the answer?

Rheumatoid factor is sensitive but also positive in other chronic infections and diseases.

What concept does this question test?

It tests Immunopathology: rheumatoid arthritis in Pathology. Rheumatoid factor is more sensitive but less specific, being found in hepatitis C, endocarditis and ageing. Histology shows pannus formation by synovial hyperplasia with chronic inflammation.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Immunopathology: rheumatoid arthritis?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.