Which medication is considered a first-line disease-modifying antirheumatic drug for rheumatoid arthritis?

Which medication is considered a first-line disease-modifying antirheumatic drug for rheumatoid arthritis?

• A. Methotrexate
• B. Leflunomide
• C. Hydroxychloroquine
• D. Sulfasalazine

Answer: (A)

Initiating a disease-modifying antirheumatic drug early in rheumatoid arthritis with methotrexate provides the strongest overall track record for reducing joint inflammation, slowing erosive damage, and improving long-term function. At low weekly doses, methotrexate acts as an immune-modulating agent that dampens inflammatory pathways involved in RA. It has extensive, well-established evidence demonstrating not only symptom relief but also the slowing of radiographic progression, which is why it is the go-to first-line option. In practice, it is often started promptly and can be combined with other agents, with folic acid given to reduce common side effects. Typical starting and titration aim for around 15 to 20 mg per week, up to about 25 mg per week as tolerated, with regular monitoring of liver enzymes, blood counts, and pregnancy potential. Other conventional DMARDs like leflunomide, hydroxychloroquine, and sulfasalazine are effective but generally have slower onset or less robust data on preventing structural damage when used alone, so they are more commonly used as second-line options or in combination rather than as the initial choice.

Initiating a disease-modifying antirheumatic drug early in rheumatoid arthritis with methotrexate provides the strongest overall track record for reducing joint inflammation, slowing erosive damage, and improving long-term function. At low weekly doses, methotrexate acts as an immune-modulating agent that dampens inflammatory pathways involved in RA. It has extensive, well-established evidence demonstrating not only symptom relief but also the slowing of radiographic progression, which is why it is the go-to first-line option. In practice, it is often started promptly and can be combined with other agents, with folic acid given to reduce common side effects. Typical starting and titration aim for around 15 to 20 mg per week, up to about 25 mg per week as tolerated, with regular monitoring of liver enzymes, blood counts, and pregnancy potential. Other conventional DMARDs like leflunomide, hydroxychloroquine, and sulfasalazine are effective but generally have slower onset or less robust data on preventing structural damage when used alone, so they are more commonly used as second-line options or in combination rather than as the initial choice.