A 46-year-old woman presents with 6 months of symmetrical pain and swelling of the wrists and metacarpophalangeal joints, morning stiffness lasting mo...

Question

A 46-year-old woman presents with 6 months of symmetrical pain and swelling of the wrists and metacarpophalangeal joints, morning stiffness lasting more than 1 hour and elevated ESR. Hand X-rays show early joint space narrowing. What is the most appropriate initial disease-modifying treatment?

Accepted Answer

Start methotrexate with appropriate monitoring

Answer

Start non-steroidal anti-inflammatory drugs only

Answer

Start low-dose prednisolone alone

Answer

Start hydroxychloroquine monotherapy for all cases

Answer

Delay disease-modifying therapy until erosions are advanced

ca-mccqe1 MCQ (SBA): Rheumatoid arthritis initial DMARD

A 46-year-old woman presents with 6 months of symmetrical pain and swelling of the wrists and metacarpophalangeal joints, morning stiffness lasting more than 1 hour and elevated ESR. Hand X-rays show early joint space narrowing. What is the most appropriate initial disease-modifying treatment?