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Drug of Choice Cheatsheet — Rheumatology (MRCP Part 1)

TL;DR

This drug of choice cheatsheet — rheumatology focus (MRCP Part 1) distils key first-line treatments for the most frequently tested rheumatological conditions in the exam. It provides concise rationales, a mini-case for application and a practical high-yield study checklist. Use alongside your question bank and mock test practise for maximal recall.


Why this matters

In the MRCP Part 1 exam, rheumatology questions often hinge on which drug you pick first, based on a condition scenario — not just knowing many drugs, but recognising the correct choice. Familiarity with major guidelines (e.g., National Institute for Health and Care Excellence (NICE), British Society for Rheumatology) can support your reasoning. For efficient revision, this cheatsheet complements your core study resources including the general MRCP Part 1 hub, the Free MRCP MCQs and the Start a mock test workflow.


1. High-yield “Drug of Choice” list (Rheumatology)

Condition

Drug of Choice

Key Rationale

Rheumatoid arthritis (RA)

Methotrexate

Recommended first-line cDMARD in NICE guideline NG100 for newly diagnosed RA. NICE+1

Systemic lupus erythematosus (SLE) (mild–moderate)

Hydroxychloroquine

Evidence supports reduction in flares and improved survival; safe immunomodulator.

Acute gout attack

NSAID (e.g., indometacin)

Rapid pain relief unless contraindications; gout guideline via BSR. rheumatology.org.uk

Gout – urate-lowering prophylaxis

Allopurinol

First-line xanthine oxidase inhibitor; start after acute flare subsides.

Ankylosing spondylitis (axial)

NSAIDs

First-line therapy for spinal pain and stiffness; used before stepping up to biologics.

Giant cell arteritis

High-dose prednisolone

Immediate initiation essential to prevent visual loss; guideline emphasises urgency. rheumatology.org.uk

Polymyalgia rheumatica

Low-dose prednisolone

Typical quick response used as diagnostic indicator; taper gradually.

Systemic sclerosis (Raynaud’s component)

Nifedipine (or other CCB)

Improves digital perfusion in secondary Raynaud’s; often first pharmacological step.

Polyarteritis nodosa (HBsAg-negative)

Cyclophosphamide + steroids

Immunosuppression reduces relapse/mortality; key in vasculitis treatment.

Psoriatic arthritis

Methotrexate

Controls both skin and joint disease; as per BSR biologics guideline. rheumatology.org.uk

Behçet’s disease (mucocutaneous/arthritic)

Colchicine

Useful for mucocutaneous flares and arthritis in Behçet’s; often first-line option.

Tip: In your revision, group drugs by mechanism + indication, not by memorising names alone. For example: “methotrexate → first-line DMARD in RA, psoriatic arthritis”.


Rheumatology drug of choice study notes for MRCP Part 1 revision.

2. Top 5 sub-topics most tested in MRCP Part 1

  1. RA management ladder – initiation of DMARDs, treat-to-target strategy, bridging with steroids.

  2. Gout therapy distinction – acute vs prophylaxis, timing of allopurinol, contraindications.

  3. Large-vessel and small-vessel vasculitides – steroid urgency (e.g., giant cell arteritis) and cytotoxic step-up.

  4. Autoimmune connective tissue disease pharmacology – SLE, systemic sclerosis: immunomodulators, biologics.

  5. Spondyloarthropathies and biologic escalation – NSAIDs baseline, when to escalate to TNF inhibitors/targeted therapy.


3. Practical example / mini-case

Case: A 68-year-old woman presents with new-onset headache, scalp tenderness, jaw claudication. ESR is 105 mm/hr. What is the most appropriate initial treatment? Answer: Start high-dose oral prednisolone immediately (before biopsy) because this is strongly suggestive of giant cell arteritis and you must act to prevent irreversible visual loss. Explanation: In suspected large-vessel vasculitis such as giant cell arteritis, prompt administration of glucocorticoids is standard of care; delaying until biopsy risks serious complication. This is a classic MRCP Part 1 scenario testing decision-making under urgency.


4. Practical study checklist — Pharmacology recall

Use the following 5-step checklist to embed drug-of-choice recall into your revision routine:

  1. ✅ Group by mechanism – e.g., “DMARDs, cortico­steroids, biologics, NSAIDs, urate-lowering agents”.

  2. 🧠 Flashcards – Front: “Condition”; Back: “Drug of choice + rationale”.

  3. 🕓 Spaced-revision – 5 minutes each morning and evening dedicated to this list.

  4. 📘 Active QBank practice – Use Free MRCP MCQs to pick scenarios and pick the right drug.

  5. 📊 Mock-test reflection – After each mock (via Start a mock test), log each drug you missed and review it the next day.


5. Common pitfalls & actionable fixes

  • Confusing acute vs prophylactic gout therapy (e.g., prescribing allopurinol during acute flare) → Fix: memorise start-after-flare rule.

  • Forgetting hydroxychloroquine monitoring (retinal toxicity) → Fix: add side-effects to your flashcard.

  • Using NSAIDs in patients with renal vasculitis/comorbidities → Fix: scan scenarios for contraindications.

  • Ignoring latent TB screening before commencing anti-TNF therapy in spondyloarthropathy → Fix: include “TB screen first” in your checklist.

  • Delaying initiation of steroids in suspected giant cell arteritis → Fix: remember the “visual-loss urgency” trigger.

  • Treating mild-moderate RA with biologics too early without trying DMARDs first, despite guidance. → Fix: anchor to NICE guideline NG100 sequence. NICE

  • Assuming biologics are tested in MRCP Part 1 level when often the question focuses on first-line agents → Fix: prioritise knowing first-line agents well.


FAQs

1. How many rheumatology questions appear in MRCP Part 1?

Typically around 10–15% of the paper covers rheumatology, among other musculoskeletal and connective-tissue areas. MedCourse

2. Are drug mechanisms directly tested in MRCP Part 1?

Yes — many questions test why you choose a drug (mechanism, indication, contraindication) rather than just which name

.3. Should I memorise all biologic agents for this exam?

Know representative examples (e.g., infliximab, etanercept) and broadly what they target (TNF-α, IL-17) but focus on first-line agents.

4. Is methotrexate always first-line in RA for MRCP Part 1?

Yes, unless contraindicated (e.g., hepatic impairment, pregnancy). NICE NG100 recommends cDMARD monotherapy (methotrexate, leflunomide, or sulfasalazine) as first step. NICE

5. What’s the best way to revise the pharmacology of rheumatology?

Use high-yield lists (like above), flashcards, QBank practise and mock exams focusing on decision-making rather than rote memory.


Ready to start?


Use this cheatsheet as one of your rapid-revision tools alongside the MRCP Part 1 overview hub. Make sure you are practising with the Free MRCP MCQs and periodically challenge yourself with a full-length mock test. At Crack Medicine, our aim is to support high-yield, exam-focused revision — for your lectures, question bank and app-based analytics, visit our main platform. Good luck and happy revision!


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