This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Rheumatoid Ahritis, Subject name: Medicine
A female repos symmetrical small joint polyahritis for 2 weeks. Labs show rheumatoid factor levels at 1:320 (positive is 1:40) and anti-CCP at 58 units (40 to 59 units are considered strongly positive). An antinuclear antibody test is negative. Labs also reveal positive cytomegalovirus and paravovirus IgG, and negative parvovirus IgM. The ESR is 62 mm/hour. What is the appropriate next step in the management of this patient? 
Select and explain. 
A. Naproxen 500 mg twice a day and follow up in 1 month, B. Methotrexate 12.5 mg a week with liver function tests in 1 month, C. Anti-histone antibodies, anti-DS-DNA, and complement levels, D. Prednisone 60 mg a day and follow up in 2 weeks
B: Methotrexate 12.5 mg a week with liver function tests in 1 month
Answer: B: Methotrexate 12.5 mg a week with liver function tests in 1 month 
Explanation: It is a Dx of RA Option A: Naproxen not recommended, straight away sta with DMARDS Option B: Methotrexate is given, as it comes under DMARDS. Option C: Anti-Histone antibodies used in drug induced SLE. Option D: We do not use steroids as routine measure in RA.