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Rheumatoid Arthritis — RACP Adult Medicine MCQ

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ModerateRheumatologyRheumatoid ArthritisRACP Adult Medicine

A 60-year-old woman with rheumatoid arthritis on methotrexate 20 mg weekly and folic acid develops persistent disease activity (DAS28 >5.1) despite 6 months of therapy. What is the most appropriate next step?

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Correct answer: B — Add a TNF inhibitor (e.g. adalimumab)

In RA with persistently high disease activity despite adequate methotrexate therapy (at least 25 mg/week for ≥3 months, or maximum tolerated dose), the next step is addition of a biologic DMARD. TNF inhibitors (adalimumab, etanercept, infliximab) are typically first-line biologics and are PBS-listed for this indication in Australia. Methotrexate should be continued as combination therapy improves outcomes.

Reference: eTG – 2025 – Rheumatology; ARA – 2024 – RA Management Guidelines; PBS Schedule – 2025