American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the preferred first-line monotherapy for early rheumatoid arthritis of less than 6 months' duration?

1. Methotrexate

2. Hydroxychloroquine

3. Sulfasalazine

4. Cyclophosphamide

The correct answer is: Methotrexate

The preferred first-line monotherapy for early rheumatoid arthritis of less than 6 months' duration is methotrexate. This choice is supported by extensive clinical evidence and guidelines from rheumatology organizations, which indicate that methotrexate is effective in controlling disease activity and preventing joint damage. Methotrexate is a disease-modifying antirheumatic drug (DMARD) that acts by inhibiting cellular proliferation and modulating immune responses, making it particularly effective in the treatment of rheumatoid arthritis. It can lead to significant improvements in symptoms and slow the progression of the disease, which is crucial during the early stages when joint damage can begin to occur. Other treatment options, while they may have some efficacy, are not preferred as initial monotherapy for early rheumatoid arthritis. Hydroxychloroquine, for example, is often used in mild cases or in combination with other DMARDs but is typically not strong enough to adequately address the disease's systemic nature when presented early on. Sulfasalazine can also be used but is generally considered less effective than methotrexate in the early stages. Cyclophosphamide is a more aggressive treatment option, used primarily in severe cases or specific complications of autoimmune diseases, including rheumatoid arthritis, but is not