Rheumatoid Arthritis and Inflammatory Spondyloarthropathies — WACS Viva & Clinical Scenarios (Rheumatology and Clinical Immunology)

Exam-style rheumatoid arthritis and inflammatory spondyloarthropathies viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 34-year-old woman presents with a 4-month history of bilateral hand and wrist pain, marked morning stiffness lasting over 90 minutes, and persistent fatigue. Physical examination reveals symmetrical swelling and tenderness of the second and third metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints bilaterally. Outline your diagnostic workup using current classification criteria, interpret potential serological markers, and formulate an initial treat-to-target pharmacotherapeutic plan.
• SCENARIO 2: A 26-year-old man presents with chronic lower back and buttock pain of 8 months duration that worsens with rest and improves with physical activity, accompanied by alternating buttock pain and morning stiffness lasting 2 hours. Describe the clinical bedside evaluation, diagnostic imaging pathway, interpretation of HLA-B27 testing, and the stepwise management strategy from first-line anti-inflammatory agents to biologic therapies.
• SCENARIO 3: A 42-year-old man with long-standing plaque psoriasis presents with dactylitis of the right third toe, asymmetric swelling of the right knee, and pain and swelling at the Achilles tendon insertion. Detail the classification criteria for psoriatic arthritis, the clinical differentiation from rheumatoid arthritis and gout, and the therapeutic approach addressing both axial and peripheral manifestations.
• SCENARIO 4: A 22-year-old male university student develops acute asymmetric oligoarthritis affecting his left knee and right ankle, accompanied by dysuria and bilateral conjunctival injection 3 weeks following an episode of diarrhoeal illness. Discuss the diagnostic evaluation, differential diagnoses including endemic infectious arthritides in West Africa, and the comprehensive management protocol.
• SCENARIO 5: A 48-year-old woman with severe, erosive rheumatoid arthritis poorly controlled on combination conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) is being evaluated for initiation of a tumour necrosis factor (TNF) alpha inhibitor. Outline the mandatory pre-biologic screening protocol tailored to the West African endemic setting, baseline laboratory investigations, vaccination considerations, and long-term toxicity surveillance.