Question

A 64-year-old woman with long-standing rheumatoid arthritis has persistent joint swelling and morning stiffness despite maximally tolerated NSAIDs. Radiographs show early erosive changes. According to Canadian Rheumatology Association recommendations, what is the most appropriate next step in disease-modifying therapy?

Accepted Answer

Begin methotrexate as a conventional disease-modifying antirheumatic drug

Answer

Continue NSAIDs alone and monitor yearly

Answer

Start low-dose oral corticosteroids as sole long-term therapy

Answer

Refer directly for biologic therapy without trying conventional DMARDs

Answer

Treat with opioids for chronic pain control only

Practice question