19th January 2024

A 35-year-old male presents to rheumatology clinic with a 13-month history of pain, swelling and tenderness of multiple joints in both hands.

A 35-year-old male presents to rheumatology clinic with a 13-month history of pain, swelling and tenderness of multiple joints in both hands. He has a past medical history of psoriasis and asthma. On examination, He has swelling and tenderness in the distal interphalangeal joints of the second, third and fourth fingers of both hands. He had been taking oral paracetamol to manage the pain, which he reports had initially helped ease his symptoms; however, over the past few months, the pain has been getting worse, and he has been unable to carry out his daily tasks. 

Blood test results showed the following.

Hb 144 g/L (130-180)

MCV 92.5fL (80-96)

WCC 11.0 x 10⁹/L (4.0-11.0)

CRP 45 mg/L (<10)

Sodium 137 (133–146 mmol/L)

Potassium 3.6 (3.5–5.3 mmol/L)

Creatinine 50 (45–84 μmol/ L)

EGFR >90 

What is the most appropriate next-line management for this man?

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