This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: NSAIDs, Gout and Rheumatoid Ahritis, Subject name: Pharmacology
First choice DMARD in rheumatoid ahritis is 
Select and explain. 
A. Gold salts, B. Penicillamine, C. Methotrexate, D. Sulfasalazine
C: Methotrexate
Answer: C: Methotrexate 
Explanation: Rheumatoid Ahritis - Pain and inflammation of joints - For acute treatment we use: - NSAIDS - Steroids But it is only symptomatic treatment. It cannot slow down the joint destruction DMARDs- (Disease modifying anti-rheumatoid drugs) - As they are very slow acting so they are also called SAARDs (slow acting anti rheumatic drugs). Classification Conventional DMARDs Biologicals Chloroquine Penicillamine Azathioprine Gold salts Leflunomide Immunosuppressants Methotrexate (DOC) sulfasalazine Anakinra Sarilumab Adalimumab Cerolizumab Etanercept Infliximab Golimumab Abatacept Methotrexate - Drug of choice - Acts by increasing adenosine which possesses anti-inflammatory activity. DMARD of choice in pregnancy - CHLOROQUINE Sulfasalazine: It is a prodrug& can be used in ankylosing spondylitis.