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MediumRheumatologyRheumatoid arthritis initial managementca-mccqe1ca-ccfpca-rcpsc-im

A 58-year-old woman with rheumatoid arthritis presents with early morning stiffness lasting 2 hours and symmetrical swelling of MCP and PIP joints for 4 months. RF and anti-CCP antibodies are positive, and X-rays show no erosions. According to Canadian rheumatology guidance, what is the most appropriate initial disease-modifying treatment?

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