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MediumRheumatologyRheumatoid arthritis initial therapyca-mccqe1ca-rcpsc-im

A 55-year-old woman presents with symmetric swelling and morning stiffness of the metacarpophalangeal and proximal interphalangeal joints for 3 months. ESR and CRP are elevated, and rheumatoid factor and anti-CCP antibodies are positive. According to Canadian Rheumatology Association recommendations, what is the most appropriate initial disease-modifying treatment?

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