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Rheumatoid Arthritis — UKMLA MCQ

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HardRheumatologyRheumatoid ArthritisUKMLAMRCP Part 1MRCGP AKTPARAPSA

A patient with newly diagnosed rheumatoid arthritis has taken an optimised dose of methotrexate for an adequate interval, but the treat-to-target goal has not been achieved. Adherence is good and there is no contraindication to another conventional DMARD. What is the next disease-modifying strategy?

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Correct answer: E — Add another conventional DMARD using a step-up combination strategy

NICE uses a treat-to-target approach in active rheumatoid arthritis. When the target has not been achieved despite dose escalation of the first conventional synthetic DMARD, additional conventional DMARDs should be offered in combination using a step-up strategy. Disease activity and CRP should be measured regularly while active treatment is adjusted. Long-term glucocorticoid monotherapy does not prevent structural progression and carries substantial harm. Biologic or targeted treatment is considered through the relevant eligibility pathway after an adequate conventional DMARD strategy, rather than automatically after one drug.

Reference: NICE NG100, step-up conventional DMARD treatment. https://www.nice.org.uk/guidance/ng100/chapter/recommendations