Which of the following has the biggest impact in limiting RA progression?

• A. Indomethacin
• B. Methotrexate
• C. Prednisone (PO)
• D. Prednisone (IV)

Answer: (B)

In rheumatoid arthritis, the ability to slow or halt structural joint damage comes from disease-modifying therapies, with methotrexate standing out as the most effective first-line option. Indomethacin and prednisone can rapidly reduce inflammation and symptoms, but they don’t consistently alter the underlying disease course or prevent radiographic progression in the long term; steroids carry significant long-term side effects, and NSAIDs don’t modify disease biology. Methotrexate works by dampening immune cell activity and promoting anti-inflammatory effects, which translates into less synovitis and slower erosion of cartilage and bone. This disease-modifying effect is what makes methotrexate the best choice for limiting progression in RA.