RA in Remission — RACP Adult Medicine MCQ

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HardRheumatologyRA in RemissionRACP Adult Medicine

A 62-year-old man with RA achieves sustained remission (DAS28 <2.6) for 12 months on methotrexate and adalimumab. He wants to simplify his treatment. What is the most appropriate strategy?

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Correct answer: E — Switch to leflunomide

In sustained remission on bDMARD + methotrexate, dose reduction or spacing of the biologic can be attempted. If biologic withdrawal is considered, the csDMARD (methotrexate) should be continued. Among the available options, leflunomide as a csDMARD alternative to methotrexate (if methotrexate toxicity) allows biologic cessation while maintaining DMARD therapy. The key principle is never withdraw all DMARDs.

Reference: EULAR – 2022 – RA Management; ARA 2024