A 44-year-old woman has symmetric swelling and morning stiffness of the MCP and PIP joints for 4 months. Rheumatoid factor and anti-CCP antibodies

Question

A 44-year-old woman has symmetric swelling and morning stiffness of the MCP and PIP joints for 4 months. Rheumatoid factor and anti-CCP antibodies are positive. X-rays show early erosions. She is not pregnant. Which of the following is the most appropriate next step in management?

Accepted Answer

Start methotrexate with folic acid

Answer

Delay treatment until deformities develop

Answer

Use acetaminophen as sole disease-modifying therapy

Answer

Start long-term antibiotics

Answer

Perform bilateral hand surgery first

Rheumatoid arthritis — USMLE Step 3 MCQ

A 44-year-old woman has symmetric swelling and morning stiffness of the MCP and PIP joints for 4 months. Rheumatoid factor and anti-CCP antibodies are positive. X-rays show early erosions. She is not pregnant. Which of the following is the most appropriate next step in management?