A 62-year-old woman with long-standing rheumatoid arthritis presents with morning stiffness, small joint swelling and elevated inflammatory markers de...

Question

A 62-year-old woman with long-standing rheumatoid arthritis presents with morning stiffness, small joint swelling and elevated inflammatory markers despite methotrexate at 25 mg weekly and folic acid. According to Canadian RA management guidelines, what is the next best step?

Accepted Answer

Add a biologic DMARD (e.g., TNF inhibitor) or targeted synthetic DMARD after confirming inadequate response to methotrexate.

Answer

Switch to hydroxychloroquine monotherapy.

Answer

Increase methotrexate indefinitely beyond 25 mg weekly.

Answer

Treat only with NSAIDs for symptom control.

Answer

Stop methotrexate and observe.

ca-mccqe1 MCQ (SBA): Rheumatoid arthritis treatment escalation

A 62-year-old woman with long-standing rheumatoid arthritis presents with morning stiffness, small joint swelling and elevated inflammatory markers despite methotrexate at 25 mg weekly and folic acid. According to Canadian RA management guidelines, what is the next best step?