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RA Window of Opportunity — RACP Adult Medicine MCQ

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ModerateRheumatologyRA Window of OpportunityRACP Adult Medicine

A 42-year-old woman presents with a 12-month history of fatigue, morning stiffness lasting 3 hours, and symmetrical polyarthritis affecting MCPJs, PIPJs, wrists, and MTPs. RF is strongly positive and anti-CCP is strongly positive. CRP is 65 mg/L. X-rays show juxta-articular osteopaenia and erosions in the MCPJs. What is the window of opportunity concept in RA management?

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Correct answer: C — Biologic therapy should always be first-line

The 'window of opportunity' in RA refers to the critical period early in the disease (ideally within 3–6 months of symptom onset) during which aggressive DMARD therapy (methotrexate first-line, ideally within 6 weeks of diagnosis) produces the best long-term outcomes in terms of remission rates, joint preservation, and prevention of erosive damage. Delays in commencing DMARD therapy beyond this window result in worse outcomes that cannot be fully recovered even with later treatment intensification. This underpins the 'treat-to-target' strategy in RA (target: clinical remission or low disease activity).

Reference: eTG – 2025 – Rheumatology; EULAR – 2022 – RA Treatment Recommendations