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Early Rheumatoid Arthritis — RACP Adult Medicine MCQ

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EasyRheumatologyEarly Rheumatoid ArthritisRACP Adult Medicine

A 65-year-old woman presents with symmetric polyarthritis affecting the MCP and PIP joints bilaterally, morning stiffness lasting 2 hours, and fatigue. RF is positive (titre 1:320) and anti-CCP antibody is strongly positive. X-rays show periarticular erosions of the second and third MCP joints bilaterally. ESR is 55 mm/hr. What is the most appropriate initial DMARD therapy?

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Correct answer: C — Methotrexate (oral or subcutaneous)

Seropositive (RF+, anti-CCP+) erosive RA requires early DMARD therapy. Methotrexate (15–25 mg/week, oral or subcutaneous) is the anchor DMARD and should be started within 3 months of symptom onset. Subcutaneous methotrexate has better bioavailability. Folic acid 5 mg weekly (not on MTX day) is mandatory. Short-term bridging prednisolone may be used while awaiting MTX effect.

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