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Rheumatoid arthritis — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Rheumatoid arthritisUSMLE Step 3

A 46-year-old woman has 4 months of symmetric swelling and morning stiffness of the wrists and MCP joints lasting 90 minutes. Anti-CCP antibody is positive and radiographs show early erosions. She has no liver disease or pregnancy plans. Which of the following is the most appropriate next step in management?

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Reveal the answer and explanation

Correct answer: E — Start methotrexate therapy

Methotrexate is first-line disease-modifying therapy for active rheumatoid arthritis unless contraindicated.

Reference: ACR Rheumatoid Arthritis Guideline