If methotrexate does not work for RA, what is a common next step?

• A. Leflunomide
• B. TNF alpha inhibitors
• C. Rituximab
• D. Abatacept

Answer: (B)

When methotrexate isn’t providing adequate control of rheumatoid arthritis, the common next step is to escalate therapy by adding a biologic DMARD that targets a key inflammatory pathway, most often a TNF-alpha inhibitor. Blocking TNF-alpha helps reduce synovial inflammation, slow joint damage, and improve symptoms and function. Using a TNF inhibitor in combination with methotrexate enhances efficacy and lowers the chance that the body will develop antibodies against the biologic, making the treatment more effective over time. Other biologics such as rituximab or abatacept can be used in certain situations or after TNF inhibitors, and non-biologic options like leflunomide are alternatives, but the typical next step after MTX failure is adding a TNF-alpha inhibitor.