A 36-year-old woman is diagnosed with rheumatoid arthritis (RA) and asks the NP about her treatment options. Which of the following is considered first-line treatment for RA?

Choice A reason: NSAIDs are commonly used to relieve pain and inflammation in RA, but they do not alter the disease course or prevent joint damage. They are considered adjunctive therapy rather than first-line disease-modifying treatment. Choice B reason: Methotrexate is the cornerstone and first-line disease-modifying antirheumatic drug (DMARD) for RA. It reduces inflammation, slows disease progression, and prevents joint damage. It has a well-established efficacy and safety profile and is recommended by major rheumatology guidelines as the initial treatment for most patients with RA. Choice C reason: Corticosteroid injections may be used for localized joint inflammation or as a bridge therapy while waiting for DMARDs to take effect. However, they are not considered first-line long-term treatment due to potential systemic side effects and lack of disease-modifying properties. Choice D reason: Opioids are not recommended for RA management due to their risk of dependence and lack of anti-inflammatory or disease-modifying effects. They may be used in exceptional cases for severe pain but are not part of standard RA treatment protocols.