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First-line treatment typically involves: Methotrexate – the most commonly prescribed conventional synthetic DMARD Sulfasalazine or hydroxychloroquine – alternative or combination options Leflunomide – for patients who cannot tolerate methotrexate These medications are usually combined with short-term corticosteroids (such as prednisolone) to provide rapid symptom relief whilst DMARDs take effect, which can take several weeks to months
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