10-year Seropositive Rheumatoid Arthritis in Medicine / Internal Medicine — 48yo Woman | Rheumatology | SMLE Q#1095
SMLE Question #1095
Medicine / Internal Medicine
Rheumatology
Last updated: February 2026
A 48-year-old woman with a 10-year history of seropositive rheumatoid arthritis has 3 weeks of worsening bilateral hand pain and prolonged morning stiffness despite methotrexate 20 mg weekly and prednisolone 5 mg daily. Examination shows tenderness and mild swelling of the metacarpophalangeal and proximal interphalangeal joints bilaterally (tender joint count 10, swollen joint count 6). She reports good adherence and no recent infection symptoms. What is the most appropriate next step in management?
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