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Rheumatoid Arthritis — RACP Adult Medicine MCQ

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ModerateRheumatologyRheumatoid ArthritisRACP Adult Medicine

A 45-year-old woman with rheumatoid arthritis on methotrexate 25 mg/week presents with worsening joint symptoms despite adequate methotrexate. DAS28 remains >5.1 after 6 months. She has no contraindications. What is the most appropriate next step?

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Correct answer: A — Add a TNF inhibitor (adalimumab)

Inadequate response to maximally tolerated methotrexate (DAS28 >5.1 = high disease activity) after 6 months warrants escalation to a biologic DMARD. Anti-TNF agents (adalimumab, etanercept, infliximab) are the standard first-line biologic, added to ongoing methotrexate. Australian PBS criteria require failure of ≥2 csDMARDs for bDMARD access.

Reference: ARA – 2024 – RA Treatment Guidelines; EULAR 2022 RA Management