A 52-year-old man with a 10-year history of rheumatoid arthritis presents with progressive joint pain, swelling, and morning stiffness lasting 2 hours. Inflammatory markers (ESR 68 mm/h, CRP 12 mg/dL) are elevated. He has failed NSAIDs and low-dose prednisolone monotherapy. Which is the drug of choice for disease-modifying therapy in this patient?

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