To promote optimal health and limit morbidity and mortality in rheumatoid arthritis, which therapy is most appropriate?

• A. Meningococcal vaccination
• B. NSAIDs for disease modification
• C. Methotrexate
• D. Corticosteroids as first-line therapy

Answer: (C)

Early, disease-modifying therapy is crucial in rheumatoid arthritis to prevent joint damage and improve long-term survival. Methotrexate acts as a disease-modifying antirheumatic drug (DMARD) that slows radiographic progression, improves function, and reduces morbidity and mortality when started promptly and used chronically with appropriate monitoring. It addresses the underlying inflammatory process rather than just masking symptoms. NSAIDs and corticosteroids can relieve pain and control flares but do not prevent joint destruction, and corticosteroids carry significant adverse effects with long-term use, making them less suitable as first-line long-term therapy. Vaccinations such as meningococcal protection are important for overall health, especially if immunosuppressed, but they do not alter the disease course. Therefore methotrexate is the best option to promote optimal health in rheumatoid arthritis.