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Treat-to-Target Explained — SCE Rheumatology MCQ

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HardRheumatoid ArthritisTreat-to-Target ExplainedSCE Rheumatology

A patient with seropositive RA has maintained stringent remission for 9 months on methotrexate plus an adalimumab biosimilar. Prednisolone was stopped 8 months ago and there is no radiographic progression. She asks to stop both DMARDs immediately. What is the best response?

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Correct answer: D — Reduce one DMARD cautiously, explaining that full withdrawal increases flare risk

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as E

D is correct. EULAR allows cautious DMARD dose reduction after glucocorticoids are stopped and stringent remission has persisted for at least 6 months, but warns that complete withdrawal produces frequent flares; there is no mandatory first drug to taper. A denies an available strategy. B equates remission with cure. C reintroduces the medicine that should already be discontinued. E substitutes one imaging test for the longitudinal clinical decision.

Reference: EULAR rheumatoid arthritis management recommendations 2022: https://ard.bmj.com/content/82/1/3