Rheumatoid Arthritis — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRheumatologyRheumatoid ArthritisSCE Rheumatology

A 58-year-old with rheumatoid arthritis on methotrexate has active disease. According to ACR 2021, what is the next step after inadequate response to a conventional synthetic DMARD?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Add a biologic or targeted synthetic DMARD

Explanation lettering: D = shown as A · E = shown as B · B = shown as D · A = shown as E

The ACR 2021 guidelines recommend adding a biologic DMARD (bDMARD) or targeted synthetic DMARD (tsDMARD) after an inadequate response to a conventional synthetic DMARD (csDMARD) like methotrexate. The principle of treat-to-target is emphasized. Options A and D suggest switching to or adding other csDMARDs, which may be insufficient. Option C, long-term corticosteroid use, is generally discouraged due to side effects. Option E, stopping methotrexate without an appropriate alternative, is not indicated for active disease.

Reference: ACR Guideline (2021): Treatment of Rheumatoid Arthritis