A 42-year-old woman has 6 months of symmetrical swelling and tenderness of the metacarpophalangeal and proximal interphalangeal joints. Morning stiffness lasts 90 minutes, and examination confirms synovitis in eight joints. Her pregnancy test is negative, renal and liver function are normal, and she has no pulmonary disease. Which disease-modifying treatment should be commenced while arranging rheumatology review?
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