Question

A 14-year-old child is a naive rheumatoid arthritis patient as shown in the image. What should be the correct treatment of the given condition?

• A. DMARD with short course of steroids
• B. Only NSAIDs
• C. DMARD after initial 3 months of NSAIDs
• D. Monotherapy with TNF drugs

Hint:

Treatment-naive RA needs an early DMARD with a short steroid bridge, not NSAIDs alone or delayed therapy.

Answer 1

The Correct Option is A

Step 1: Recognise the diagnosis from the symmetrical, deforming small-joint arthritis shown: rheumatoid arthritis, an autoimmune synovitis that erodes joints if left unchecked.
Step 2: The governing principle in modern rheumatology is the window of opportunity. Starting a disease-modifying agent as early as possible in a never-treated patient prevents irreversible cartilage and bone loss, so a $DMARD$ forms the backbone of therapy.
Step 3: Because DMARDs act slowly, a brief glucocorticoid course is layered on to suppress inflammation and pain during the lag period. This combination of an early DMARD plus a short steroid bridge is the recommended naive-patient strategy.
Step 4: Contrast the wrong paths: relying on NSAIDs alone gives only symptomatic relief while joints continue to erode; postponing the DMARD for three months wastes the early window; and reaching straight for TNF-blocker monotherapy is reserved for DMARD failure, not initial care.
\[\boxed{\text{DMARD with short course of steroids}}\]