A 42-year-old woman from Delhi presents with a 6-month history of symmetrical pain and swelling of the hands, wrists, and knees. She reports morning stiffness lasting 2 hours. On examination, she has tender, swollen metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints bilaterally, with reduced grip strength. Laboratory investigations show: ESR 68 mm/h, CRP 12 mg/dL, RF 1:640, anti-CCP antibodies positive. X-ray of hands shows periarticular osteopenia and marginal erosions at MCP joints. She has no systemic features. What is the most appropriate initial pharmacological management?