Disease-Modifying Antirheumatic Drugs

A 38-year-old woman from Delhi presents with a 6-month history of symmetrical polyarthritis affecting her hands, wrists, and knees. Morning stiffness lasts 2 hours. Laboratory investigations show RF 85 IU/mL (positive), anti-CCP antibodies 120 U/mL (positive), ESR 68 mm/h, and CRP 12 mg/dL. X-rays of hands show early erosions in metacarpophalangeal joints. She has no contraindications to DMARDs. Which of the following is the most appropriate first-line DMARD for this patient?

A 45-year-old man with rheumatoid arthritis has been on methotrexate 20 mg weekly for 8 months. He has achieved good clinical response (DAS28-CRP 3.2) and his inflammatory markers have normalized. However, he now presents with fatigue, mild dyspnea on exertion, and pallor. Laboratory findings show Hb 9.2 g/dL (normal 13.5–17.5), MCV 72 fL, serum ferritin 8 ng/mL, and iron studies consistent with iron deficiency. His renal function and liver function tests are normal. What is the most likely cause of his anemia, and what is the appropriate management?

Which disease-modifying antirheumatic drug (DMARD) acts primarily by inhibiting dihydrofolate reductase and disrupting purine synthesis?

Which of the following DMARDs is contraindicated in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency due to risk of hemolytic anemia?