For subcutaneous nodules, which therapy is conditionally recommended?

• A. Leflunomide
• B. Methotrexate
• C. Rituximab
• D. Hydroxychloroquine

Answer: (B)

Subcutaneous nodules in rheumatoid arthritis respond best when systemic inflammation is reduced with a disease-modifying therapy, and methotrexate has the strongest, most consistent track record for this goal. When given as a low-dose weekly DMARD with folic acid, methotrexate effectively controls joint symptoms, slows radiographic damage, and can lessen extra-articular features tied to high inflammatory activity, including nodules. Because of its proven efficacy and widespread use as the starting backbone of RA treatment, it’s considered the most appropriate choice, with the caveat that individual factors—such as liver disease, alcohol use, pregnancy potential, and drug interactions—may influence its use. Leflunomide and hydroxychloroquine are valid alternatives but typically are not as potent for this particular presentation, while rituximab is generally reserved for refractory cases after other options.