Clinical Intake — Rheumatoid arthritis

A 58-year-old female with a 3-year history of seropositive rheumatoid arthritis diagnosed in April 2023 presents with persistent moderate-to-severe disease activity despite conventional and biologic therapy. She completed a 5-month trial of a TNF inhibitor, which was discontinued in November 2025 due to inadequate response, with DAS28-ESR remaining above 5.1 at both the 3- and 5-month assessments. She continues on weekly methotrexate with only partial benefit; current examination reveals eight swollen joints, twelve tender joints, and bilateral hand and wrist range-of-motion limitation, with markedly elevated inflammatory markers (ESR 42, CRP 2.8, RF 128, anti-CCP >250). Dr. Ramanathan has exhausted first-line biologic options and refers the patient for specialist assessment of an alternative advanced therapy.