Question

A patient of RA is taking methotrexate, steroids and NSAIDs since 4 months but activity of disease progression is same.What should be the next probable step?

• A. Start monotherapy with anti TNF alpha drugs
• B. Continue methotrexate and steroids
• C. Stop oral methotrexate and start parenteral methotrexate
• D. Add sulfasalazine

Answer 1

The Correct Option is D

In the management of rheumatoid arthritis (RA), when a patient shows no improvement in disease activity despite treatment for 4 months with methotrexate, steroids, and NSAIDs, the goal is to optimize the treatment approach by altering or adding medications. Methotrexate is a cornerstone in RA treatment; however, not all patients respond adequately to methotrexate monotherapy or in combination with steroids and NSAIDs.

The next step is to add another disease-modifying antirheumatic drug (DMARD) to enhance the therapeutic effect. Among the provided options:

• Starting monotherapy with anti-TNF alpha drugs would typically be considered if the patient had an inadequate response to methotrexate and other DMARDs. However, such a dramatic change might not be the immediate next step in this scenario.
• Continuing with methotrexate and steroids alone is not adequate because it has not controlled the disease progression effectively so far.
• Switching from oral to parenteral methotrexate may improve efficacy slightly but might not be sufficient if the current combination is inadequate.
• Adding sulfasalazine is a reasonable choice as it is a well-established DMARD used in combination therapy to achieve better control of disease activity in RA patients who are not adequately responsive to methotrexate alone.

Considering the treatment regimen and patient response so far, the correct approach is to add sulfasalazine to the existing treatment plan with methotrexate, potentially improving therapeutic outcomes by combining their effects.