Which one of the following is the preferred first-line agent in the treatment of rheumatoid arthritis with moderate disease activity? A. Adalimumab (Humira) B. Etanercept (Enbrel) C. Hydroxychloroquine (Plaquenil) D. Methotrexate (Trexall) E. Prednisone
Ritu Suri
2mo
D.
Answer: D The American College of Rheumatology recommends methotrexate, a nonbiologic disease-modifying antirheumatic drug (DMARD), as a first-line agent in the treatment of rheumatoid arthritis in those with moderate to severe disease activity. Hydroxychloroquine or sulfasalazine may be used in those DMARD naïve patients who have low disease activity. Starting DMARDs within 3 months of the onset of rheumatoid arthritis symptoms is more likely to result in sustained remissions. The addition of short-term prednisone is indicated in select cases when disease activity is high. The use of biological agents such as adalimumab, etanercept, and others is indicated only in refractory cases and in patients who cannot tolerate nonbiologic DMARDs.