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Early rheumatoid arthritis — SCE Rheumatology MCQ

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ModerateRheumatoid arthritisEarly rheumatoid arthritisSCE Rheumatology

A 48-year-old woman has newly diagnosed active rheumatoid arthritis with 9 swollen joints and raised CRP. Examination shows bilateral wrist and MCP synovitis. Investigations show normal FBC, LFTs and eGFR, negative hepatitis B/C and no pregnancy plans. What is the most appropriate management?

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Correct answer: A — Start methotrexate with folic acid and monitoring

NICE recommends conventional synthetic DMARDs promptly in active RA; methotrexate with folic acid is a standard first-line choice when there is no contraindication. Long-term glucocorticoid monotherapy may improve symptoms but does not provide adequate disease-modifying control. Early suppression of synovitis reduces erosions, disability and later biologic requirement.

Reference: NICE NG100; BSR biologic DMARD safety guideline; BNF