Question

A 48‑year‑old man presents with early morning stiffness lasting over an hour, symmetrical swelling of the MCP and PIP joints and elevated inflammatory markers. Rheumatoid factor and anti‑CCP are positive. According to best practice, which statement about initial disease‑modifying treatment is most accurate?

Accepted Answer

Methotrexate should be commenced early as first‑line DMARD unless contraindicated

Answer

Non‑steroidal anti‑inflammatories alone are sufficient to prevent joint damage

Answer

Biologic therapy should be started immediately, avoiding conventional DMARDs

Answer

Systemic corticosteroids alone are recommended as long‑term therapy

Answer

Hydroxychloroquine is preferred over methotrexate as it has greater efficacy

Practice question