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RA remission tapering — SCE Rheumatology MCQ

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ModerateRheumatoid arthritisRA remission taperingSCE Rheumatology

A 59-year-old woman with seropositive RA has been in sustained remission for 14 months on methotrexate and sulfasalazine. Examination shows no tender or swollen joints are found. Investigations show CRP is normal and hand radiographs are stable. What is the most appropriate management?

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Correct answer: C — Discuss cautious DMARD dose reduction with close monitoring

Sustained remission allows a shared decision about cautious DMARD tapering with careful monitoring for flare. Stopping every DMARD abruptly increases relapse risk and is less safe than staged reduction. Treat-to-target care includes confirming true remission and having a rapid plan to reinstate therapy if synovitis returns.

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