A 65-Year-Old Woman with a History of Rheumatoid Arthritis Comes

A 65-year-old woman with a history of rheumatoid arthritis comes to the physician with persistent hand pain aggravated by use.  She was prescribed tramadol and occupational therapy 1 year ago and has had no relief.  Rheumatoid arthritis was diagnosed 20 years ago, and she was started on methotrexate, prednisone, and hydroxychloroquine at that time.  She was prescribed etanercept 10 years ago and switched to adalimumab 5 years later due to persistent disease activity.  The patient's other medical problems include hypertension and acid reflux disease.  Her current medications include methotrexate, hydroxychloroquine, adalimumab, tramadol, prednisone, and ibuprofen.  She does not use tobacco, alcohol, or illicit drugs.
Her vital signs are normal.  Musculoskeletal examination is notable for the presence of rheumatoid deformities in the hands (shown below) and feet.  There is no joint tenderness or effusion.  Neurological examination is within normal limits.

Laboratory results are as follows:

Which of the following is the most appropriate next step in management?

A) Add infliximab to the current regimen
B) Add sulfasalazine to the current regimen
C) Prescribe a short course of high-dose prednisone
D) Refer for orthopedic evaluation
E) Switch from oral to subcutaneous methotrexate