A 45-year-old man presents with a 6-month history of symmetric joint pain and swelling primarily affecting his hands and feet, associated with morning stiffness lasting over an hour. Physical exam reveals swollen and tender metacarpophalangeal and proximal interphalangeal joints. Lab tests show elevated ESR and positive anti-CCP antibodies. Which of the following is the most appropriate initial disease-modifying antirheumatic drug (DMARD)?

The correct answer to the question "A 45-year-old man presents with a 6-month history of symmetric joint pain and swelling primarily affecting his hands and feet, associated with morning stiffness lasting over an hour. Physical exam reveals swollen and tender metacarpophalangeal and proximal interphalangeal joints. Lab tests show elevated ESR and positive anti-CCP antibodies. Which of the following is the most appropriate initial disease-modifying antirheumatic drug (DMARD)?" is Option C: Methotrexate.

The other options — A) Prednisone 20 mg daily, B) Ibuprofen 600 mg three times daily, D) Hydroxychloroquine — are incorrect for this USMLE Exam Prep question. As explained above: This presentation is consistent with rheumatoid arthritis. Methotrexate is considered the first-line conventional synthetic DMARD for most patients, initiated early to prevent joint damage and diseas…