Rheumatoid Arthritis — SCE Rheumatology MCQ

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EasyRheumatoid ArthritisRheumatoid ArthritisSCE Rheumatology

A 38-year-old woman with early RA (<3 months symptoms) has positive anti-CCP antibodies at 340 U/mL and RF at 120 IU/mL. X-rays show periarticular osteopenia but no erosions. DAS28 is 5.4. What is the initial DMARD strategy recommended by EULAR?

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Correct answer: E — Methotrexate monotherapy with short-term glucocorticoid bridging

EULAR 2022 recommends Methotrexate as the anchor first-line csDMARD, with short-term glucocorticoid bridging therapy to achieve rapid symptom control while awaiting DMARD effect. Target should be remission or low disease activity within 6 months. Despite high-risk serology, biologic therapy is not first-line. Triple therapy or combination csDMARDs can be considered if Methotrexate alone is insufficient.

Reference: EULAR 2022 - Recommendations for management of RA with synthetic and biological DMARDs