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Rheumatoid arthritis treatment target — SCE Rheumatology MCQ

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EasyInflammatory ArthritisRheumatoid arthritis treatment targetSCE Rheumatology

A 47-year-old woman with newly treated rheumatoid arthritis returns after 3 months of methotrexate. Her swollen joint count has improved from 12 to 5, but DAS28 remains 4.8 and CRP is 26 mg/L. She tolerates treatment and monitoring bloods are normal. She asks whether partial improvement is sufficient. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Escalate DMARD therapy towards remission or low disease activity

Explanation lettering: D = shown as A · A = shown as D

Escalate DMARD therapy towards remission or low disease activity is best because treat-to-target care requires adjustment of therapy when disease activity remains moderate or high despite initial improvement. B is less suitable because joint replacement is inappropriate while active inflammatory disease remains uncontrolled; C is less suitable because continuing unchanged for a year risks ongoing structural damage; D is less suitable because stopping methotrexate without a replacement would worsen disease control; E is less suitable because opioids do not modify inflammation and are not the main strategy. Clinical pearl: the target is remission or low disease activity, not simply some improvement.

Reference: NICE NG100; EULAR RA management recommendations 2022