Rheumatoid Arthritis Pathology

Which of the following antibodies is most specific for rheumatoid arthritis and is associated with more severe, erosive disease?

A 42-year-old woman from Delhi presents with a 6-month history of symmetrical swelling and morning stiffness (>1 hour) in her hands, wrists, and knees. On examination, she has soft tissue swelling of the PIP and MCP joints with ulnar deviation of the fingers. Laboratory investigations reveal: RF 85 IU/mL (positive), anti-CCP antibody 120 U/mL (positive), ESR 62 mm/h, CRP 18 mg/dL. X-ray of hands shows periarticular osteopenia and marginal erosions. Which of the following pathological processes is MOST directly responsible for the joint erosions seen in this patient?

A 38-year-old woman from Mumbai with a 3-year history of seropositive rheumatoid arthritis (RF and anti-CCP positive) presents with progressive joint destruction despite conventional DMARD therapy. A synovial biopsy from an inflamed knee joint is performed. Histological examination shows hyperplastic synovium with a dense infiltrate of CD4+ T cells, B cells, and plasma cells arranged in lymphoid aggregates with germinal centre-like structures. Numerous activated macrophages and fibroblasts are also present. Which of the following best describes the immunopathological process occurring in this synovial tissue?

A 52-year-old woman with a 3-year history of seropositive rheumatoid arthritis (RF+ and anti-CCP+) presents with persistent joint pain and swelling despite adequate doses of methotrexate monotherapy for 6 months. She has no contraindications to biologics. What is the drug of choice to add to her current regimen?

A 38-year-old man with newly diagnosed seronegative rheumatoid arthritis (RF– and anti-CCP–) and moderate disease activity is starting disease-modifying antirheumatic drug (DMARD) therapy. What is the drug of choice for initial monotherapy?