90 Minutes Of Morning in Medicine / Internal Medicine — 42yo Woman | Rheumatology | SMLE Q#317
SMLE Question #317
Medicine / Internal Medicine
Rheumatology
Last updated: February 2026
A 42-year-old woman has 3 months of progressive pain and swelling in both wrists, MCP, and PIP joints with 90 minutes of morning stiffness that improves during the day. This is her first presentation with inflammatory arthritis. Examination shows bilateral wrist and hand synovitis with mild decreased grip strength. Rheumatoid factor and anti-CCP antibodies are positive. Hand radiographs show no erosions. She has active, early rheumatoid arthritis without poor prognostic features. What is the most appropriate initial disease-modifying management?
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