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MediumRheumatologyRheumatoid arthritis - initiation of DMARDca-mccqe1ca-ccfpca-rcpsc-im

A 55-year-old woman with rheumatoid arthritis presents with persistent polyarticular pain, morning stiffness and elevated inflammatory markers despite 3 months of NSAIDs. Serology shows positive rheumatoid factor and anti-CCP antibodies. According to rheumatology guidelines, what is the most appropriate next step?

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