A patient with rheumatoid arthritis showing erosions at the ulnar styloids is treated with which medication as a sole therapy?

In the context of treating patients with rheumatoid arthritis who exhibit signs of disease progression, such as erosions at the ulnar styloids, Methotrexate stands out as a particularly effective first-line therapy. Methotrexate is a conventional disease-modifying antirheumatic drug (DMARD) that has established efficacy in slowing down the progression of rheumatoid arthritis and preventing joint damage.

This medication works by inhibiting the rapid proliferation of immune cells, thus decreasing inflammation and ultimately leading to reduced erosive changes on X-rays. The presence of erosions indicates that the disease is active and has progressed, which means that a medication with a proven ability to modify the disease course, like Methotrexate, is essential.

Other drug classes, such as hydroxychloroquine, are generally used for mild to moderate cases and are not typically sufficient for more severe presentations where joint damage is occurring. Prednisone, while it can provide rapid relief of symptoms and suppress inflammation, does not provide the long-term disease-modifying effects needed in the management of rheumatoid arthritis. Biologic therapies are often reserved for more severe or refractory cases or when other options fail, making Methotrexate the most appropriate choice for initial monotherapy in this scenario.