skip to main content

Combination csDMARD Therapy — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRheumatoid ArthritisCombination csDMARD TherapySCE Rheumatology

A 45-year-old woman with RA has failed Methotrexate monotherapy after 3 months at maximum tolerated dose. Her DAS28 is 4.6. Before escalating to biologic therapy what csDMARD strategy should be considered?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Combination csDMARD therapy (adding Sulfasalazine and/or Hydroxychloroquine to Methotrexate) or switching csDMARD

EULAR 2022 recommends that if the first csDMARD strategy (usually Methotrexate) does not achieve the treatment target within 3-6 months combination csDMARD therapy (triple therapy: Methotrexate plus Sulfasalazine plus Hydroxychloroquine) or switching to an alternative csDMARD should be considered before biologic escalation. The TEAR and tREACH trials showed combination csDMARDs were non-inferior to Methotrexate plus TNF inhibitor for many outcomes. Biologic therapy is typically reserved for patients who fail two csDMARD strategies or have poor prognostic features.

Reference: EULAR 2022 RA recommendations; O'Dell JR et al 2013 TEAR trial