5th May 2024

A 55-year-old woman presents with a six-month history of symmetrical joint pain and swelling in her hands and wrists.

A 55-year-old woman presents with a six-month history of symmetrical joint pain and swelling in her hands and wrists. She reports morning stiffness lasting more than one hour and has difficulty performing daily activities. She has no significant past medical history and is not currently pregnant or planning pregnancy. On examination, there is evident synovitis in the metacarpophalangeal and proximal interphalangeal joints. A diagnosis of rheumatoid arthritis (RA) with moderate disease activity is made.

Which is the most appropriate initial management option?