Clinical case study

Optimising rheumatoid arthritis treatment

How can you optimise a patient’s methotrexate therapy for the management of rheumatoid arthritis?

  • Cost: free

Optimising rheumatoid arthritis treatment


Jane is a 42-year-old woman who presented to her GP with a 7-week history of pain and morning stiffness of more than one hour in her hands and feet. Jane was referred to a rheumatologist who confirmed the tenderness and swelling in the small joints of her hands and ran tests which confirmed raised c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels. Jane tested negative for rheumatoid factor (RhF) and positive for anti-cyclic citrullinated peptide (anti-CCP) antibodies.

Jane presents to the pharmacy with a prescription for methotrexate and prednisolone. Which counselling points would you cover with Jane? What would be your role in optimising methotrexate therapy?

Complete this online case study and receive instant feedback on your responses, compare your approach with your peers and read expert commentary provided by Dr Mona Marabani, rheumatologist in clinical practice in Western Sydney and specialist in general medicine and rheumatology at Canterbury Hospital.


Learning outcomes

On completion of this activity you should be able to:

  • identify methotrexate as the recommended first-line therapy in rheumatoid arthritis (RA) for most patients
  • define the role of folic acid in managing adverse effects of methotrexate therapy
  • recognise potential barriers to patient adherence and help overcome them by counselling patients and dispelling common myths about methotrexate therapy
  • reinforce the importance of ongoing monitoring in RA to assess disease activity, treatment efficacy and adverse effects
  • recommend strategies to help patients with RA undertake lifestyle modifications such as stopping smoking and managing their weight.