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Rheumatoid arthritis remission — SCE Rheumatology MCQ

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HardInflammatory ArthritisRheumatoid arthritis remissionSCE Rheumatology

A 45-year-old woman with rheumatoid arthritis has sustained Boolean remission for 18 months on methotrexate and adalimumab. She has no erosions progression and no steroid use. She is keen to reduce treatment burden after shared decision-making. Infection screening is up to date. What is the most appropriate management?

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

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Correct answer: D — Consider cautious biologic dose taper with close monitoring

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

Consider cautious biologic dose taper with close monitoring is best because after sustained remission, cautious tapering of biological therapy can be considered with shared decision-making and prompt access if flare occurs. B is less suitable because prednisolone is not a remission-maintenance substitute; C is less suitable because switching to a JAK inhibitor adds risk without indication; D is less suitable because interval changes without monitoring are unsafe; E is less suitable because abruptly stopping both DMARDs risks flare. Clinical pearl: tapering is a strategy for sustained remission, not for active disease or convenience alone.

Reference: EULAR RA management recommendations 2022; NICE NG100