Which of the following statements about rheumatoid arthritis are true: (a) it affects the distal interphalangeal joints, (b) it is associated with carpal tunnel syndrome, (c) disease activity is assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), (d) functional capacity is assessed using the Health Assessment Questionnaire Disability Index (HAQ‑DI), (e) patients exhibit accelerated atherosclerosis?

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Last updated: October 4, 2026 • View editorial policy

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Rheumatoid Arthritis: Statement Analysis

Statements b, d, and e are true regarding rheumatoid arthritis, while statements a and c are false.

Statement-by-Statement Analysis

a) RA affects the distal interphalangeal joints - FALSE

Distal interphalangeal (DIP) joints are specifically excluded from RA classification criteria 1. The ACR/EULAR 2010 classification criteria explicitly state that "Distal interphalangeal joints, first carpometacarpal joints, and first metatarsophalangeal joints are excluded from assessment" 1. RA characteristically affects the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, wrists, elbows, shoulders, and knees 1.

Important caveat: While DIP involvement is extremely rare in RA (less than 0.2% of cases) 2, its presence should prompt consideration of alternative diagnoses such as psoriatic arthritis or osteoarthritis. DIP involvement is actually a distinguishing feature that helps differentiate other arthropathies from RA.

b) RA is associated with carpal tunnel syndrome - TRUE

RA patients are prone to developing carpal tunnel syndrome (CTS) 3. Recent longitudinal MRI studies demonstrate that undue median nerve swelling (the hallmark of CTS, defined as cross-sectional area >15 mm²) is present in 31% of early RA patients at baseline and increases to 46% by year 8 3.

The mechanism involves:

  • Tenosynovitis causing median nerve compression (moderate correlation at baseline, r=0.634) 3
  • Persistent nerve swelling that does not regress with treatment of synovitis 3
  • Association with long-term functional impairment (over twice as common in patients with median nerve swelling) 3

Clinical pitfall: CTS symptoms may be present in only about half of RA patients with median nerve swelling, so clinical symptoms alone underestimate the prevalence 3.

c) The SLEDAI index is used to assess disease activity - FALSE

SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) is specifically designed for lupus, not rheumatoid arthritis 4, 5. This is a fundamental error in disease-specific assessment tools.

For RA disease activity assessment, the validated composite measures include 1, 6:

  • DAS28 (Disease Activity Score using 28 joints)
  • SDAI (Simplified Disease Activity Index) - remission defined as ≤3.3
  • CDAI (Clinical Disease Activity Index) - remission defined as ≤2.8
  • RAPID-3, PAS, PAS-II (patient-reported measures)

d) Functional capacity is assessed using the HAQ-DI index - TRUE

The Health Assessment Questionnaire Disability Index (HAQ-DI) is the standard validated tool for assessing functional capacity in RA patients 1, 6, 7. The HAQ-DI is routinely used in clinical practice alongside disease activity measures 1.

Key evidence:

  • HAQ-DI is one of the core patient-reported outcomes in RA assessment 1
  • Functional capacity worsens over disease course after initial improvement 7
  • In early RA, functional capacity correlates most with disease activity; in late disease, it correlates more with joint damage 7
  • At 6 and 9 years, there is an interaction effect between joint destruction and disease activity on functional capacity 7

The HAQ-DI is incorporated into composite patient-driven measures like PAS (Patient Activity Scale) and is distinct from disease activity indices 6.

e) Patients with RA exhibit accelerated atherosclerosis - TRUE

RA is associated with 50% increase in cardiovascular morbidity and mortality due to accelerated atherosclerosis 8. This represents a major cause of premature death in RA patients.

Critical evidence:

  • RA patients younger than 50 years have a relative risk of cardiovascular events of 2.6 8
  • The main cause is accelerated atherosclerosis with increased plaque burden, plaque vulnerability, and thrombogenesis 8
  • Traditional cardiovascular risk factors alone do not fully explain the CVD excess 8, 9
  • Systemic inflammation plays a significant role beyond traditional risk factors 8, 9
  • Cardiovascular risk relates to RA activity, severity, seropositivity, physical disability, and joint damage 8

Clinical implication: Cardiovascular prevention in RA patients has been frequently inadequate, even when compared to general population recommendations 8. Aggressive lipid management and cardiovascular risk stratification should be implemented, accounting for RA-specific factors beyond traditional risk calculators.

References

1
Guideline

my treatment approach to rheumatoid arthritis.

Mayo Clinic Proceedings, 2012

2
Research

A handful of inflammation.

EULAR rheumatology open, 2026

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