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MediumRheumatologyRheumatoid arthritis initial DMARDau-racpau-amc

A 46-year-old woman presents with 6 months of symmetrical pain and morning stiffness of the small joints of the hands and wrists lasting more than 1 hour. Examination shows synovitis of MCP and PIP joints. Rheumatoid factor and anti-CCP antibodies are positive. According to guidelines, what is the most appropriate initial disease-modifying treatment?

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