Mary is a 34-year-old Caucasian woman diagnosed with rheumatoid arthritis (RA). Her initial treatment was methotrexate (MTX) 15 mg/wk orally for 4 weeks, with escalation to 20 mg/wk for another 4 weeks, and then a maintenance dose of subcutaneous MTX 25 mg/wk.

At the 6-month follow-up visit, she reports an improved overall assessment of disease activity. However, she is still experiencing some morning stiffness and functional limitations. Inflammation of joints in her hands has resulted in a loss of the ability to work. Radiographic results indicated several erosions of MCPs in each hand; her ESR was 39 mm/h and C-reactive protein (CRP) was 3.3 mg/dL. She had 8 tender and 11 swollen joints, and the disease activity score (DAS28) was 5.76, indicative of high disease activity.

The rheumatologist decides to enhance the current treatment of MTX monotherapy and considers the options of adding an additional disease-modifying antirheumatic drug (DMARD). The ideal drug of choice for Mary would one that would increase her function, reduce disease activity, and reduces radiological disease progression, while minimizing the possibility of adverse reactions.