Which action is recommended when high disease activity RA lacks adequate response after treatment changes?

• A. Switch to a bDMARD or tsDMARD
• B. Increase corticosteroids only
• C. Continue current therapy
• D. Discontinue all therapy

Answer: (A)

When rheumatoid arthritis remains highly active despite changing therapies, the aim is to alter the mechanism being targeted rather than just escalate the same treatment. Introducing a biologic DMARD or a targeted synthetic DMARD brings a different approach to immune modulation, increasing the chances of reducing joint inflammation, preventing damage, and achieving low disease activity or remission. Relying on higher doses of corticosteroids only provides short-term symptom relief and adds long-term safety risks, while continuing the same therapy without a change is unlikely to improve the high disease activity. Stopping treatment altogether would leave the disease uncontrolled. Switching to a biologic DMARD or a tsDMARD is the recommended next step because it tackles the disease through a new mechanism and offers a better path to durable control.