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MediumRheumatologyRheumatoid arthritis - initial DMARDau-racpau-amc

A 35-year-old man presents with new-onset symmetrical small joint pain and morning stiffness lasting more than 1 hour for 3 months. Examination reveals synovitis of the metacarpophalangeal and proximal interphalangeal joints bilaterally. ESR and CRP are elevated, and rheumatoid factor and anti-CCP antibodies are positive. What is the most appropriate initial disease-modifying therapy?

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