Question

A 50 year old woman has morning stiffness of hands lasting over an hour and swelling of the metacarpophalangeal and proximal interphalangeal joints bilaterally for 3 months. Rheumatoid factor and anti CCP antibodies are positive. What is the most appropriate next step in disease modifying therapy?

Accepted Answer

Commence methotrexate as an early disease modifying antirheumatic drug

Answer

Start NSAIDs only and review in 12 months

Answer

Delay DMARDs until radiographic erosions appear

Answer

Start long term oral prednisolone 10 mg daily as monotherapy

Answer

Use hydroxychloroquine only for at least 5 years before considering methotrexate

Practice question

A 50 year old woman has morning stiffness of hands lasting over an hour and swelling of the metacarpophalangeal and proximal interphalangeal joints bilaterally for 3 months. Rheumatoid factor and anti CCP antibodies are positive. What is the most appropriate next step in disease modifying therapy?