A 14-year-old girl develops painful symmetric swelling of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of both hands for 8 weeks, morning stiffness >1 hour, and anti-CCP antibodies are positive (high titre). The most appropriate initial disease-modifying treatment is:

• A Naproxen alone for 3 months before adding DMARDs
• B Prednisolone 1 mg/kg/day as monotherapy
• C Hydroxychloroquine as sole initial DMARD
• D Methotrexate (15 mg/m² once weekly oral/subcutaneous) ✓

Explanation

This presentation is consistent with seropositive (anti-CCP positive) polyarticular JIA, which has a prognosis similar to adult RA with high risk of joint destruction. Methotrexate is the anchor DMARD in polyarticular JIA, started early at 10–15 mg/m²/week, with evidence from multiple RCTs. Delaying DMARDs with NSAIDs alone risks irreversible joint damage. Hydroxychloroquine alone is insufficient for seropositive polyarticular disease. Systemic steroids are bridging agents, not primary DMARD therapy.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.