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MediumRheumatologyRheumatoid arthritisau-amcau-racp

A 58-year-old woman presents with 6 months of symmetrical pain and stiffness in the small joints of her hands and feet, worse in the morning for over an hour. Examination shows synovitis of the MCPs and PIPs. RF and anti-CCP antibodies are positive. What is the most appropriate initial disease-modifying treatment?

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