A 32-year-old woman comes to the physician because of a 3-month history of increasing pain and stif

Discussion in 'Step 3' started by samuel, Nov 30, 2013.

  1. samuel

    samuel New Member

    A 32-year-old woman comes to the physician because of a 3-month history of
    increasing pain and stiffness in her wrists, hands, and ankles. During this period,
    she also has had progressive fatigue and morning stiffness lasting 2 hours. She has
    a 1-year history of rheumatoid arthritis treated with naproxen. Examination shows
    redness, swelling, and warmth over the wrist, hand, and ankle joints bilaterally.
    There are nontender subcutaneous nodules over the extensor surfaces of both
    elbows. X-ray films of the hands show diffuse osteopenia and erosions over several
    of the distal metacarpal bones. Which of the following is the most appropriate
    pharmacotherapy?

    A) Add oral cyclophosphamide

    B) Add oral gold

    C) Add oral methotrexate

    D) Add oral penicillamine

    E ) Switch to oral ibuprofen

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