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MediumRheumatologyRheumatoid arthritisau-amcau-racp

A 47-year-old woman presents with a 6-week history of bilateral wrist and metacarpophalangeal joint pain and morning stiffness lasting 90 minutes. Examination reveals synovial thickening and tenderness of these joints. Rheumatoid factor and anti-CCP antibodies are positive, and inflammatory markers are elevated. What is the most appropriate initial disease-modifying treatment?

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