MSFinals-2484

A 25-year-old woman is seeking a referral to an obstetrician as she has been trying to conceive and her menstrual period is now one month late. She has tested positive on a home pregnancy test. She has a history of seropositive rheumatoid arthritis for the past two years and is currently only taking hydroxychloroquine as methotrexate was stopped six months ago in anticipation of conception.

During the physical examination, swelling is noted on the second and third metacarpophalangeal joints of her right hand. The pregnancy test is positive. What is the most appropriate treatment for her at this time?