18th January 2024

A 45-year-old man presents with a 3-month history of pain and stiffness of the small joints of his hands, wrists, elbows and ankles.

A 45-year-old man presents with a 3-month history of pain and stiffness of the small joints of his hands, wrists, elbows and ankles. He states that his symptoms mean that it takes him around an hour ‘to get going’ in the morning. His mother and grandmother both had a diagnosis of RA. On examination, there is swelling of the 2nd and 3rd PIP joints on the right hand and 1st MCP joint on the left hand. There is tenderness across the right wrist joint. 

Investigations:

Hb 115 g/L (115-165)

MCV 82.5fL (80-96)

WCC 6.0 x 10*9/L (4.0-11.0)

CRP 60 mg/L (<10)

RF negative 

Anti-CCP borderline positive 

U &Es Nᵢl abnormality 

LFTs Nᵢl abnormality

Which of the following is the next best management strategy?

Select the SINGLE most appropriate option from the list below. Select ONE option only.