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Discussion Starter #1
A 45-year-old female presents with swelling and pain of multiple joints. The symptoms started 6-7 months ago and gradually progressed over time. She notes prolonged morning stiffness and significant restriction of her daily activities. Which of the following drugs would provide the most rapid and complete relief of her symptoms?
a. Naproxe
b. MTX
c. Sulfasalazine
d. Hydroxychloroquine
e. Prednisone
f. Minocycline
 

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is it methotrexate...it would be predinisone if it had mentioned flares up and it would have been hyroxychloroquine if it had mentioned retinopathy
 

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Prednisone gives the FASTEST relief but should not be used for a long time because it has so many side effects. Methotrexate would provide the best relief long term but it takes a long time to start working. In clinics, the doctors I've worked under usually use a combination of the two initially just until Methotrexate starts to work then it's just Methotrexate alone. Studies have show that Methotrexate specifically given early in the disease helps prevent RA progression. (I don't remember names of studies off hand but I'm sure you can find them with a pub med or google search.) Don't forget you have to give folinic acid with Methotrexate otherwise the patient will develop folic acid deficiency. Usually, patients on Methotrexate are monitored with CBC and LFTs to make sure they don't develop harmful side effects. By the way Mtx is also teratogenic so women should use some sort of contraceptive while they're on the drug.
 

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Prednisone is my vote too - MTX is mentioned again and again as its what we use nowadays which is why I think UW wants to remind you not to forget that whats effective at solving the immediate problem is the steroid.
 

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Which of the following drugs would provide the most rapid and complete relief of her symptoms?
Yes it has to be E. Prednisone.

Naproxen will only provide some quick relief but not complete relief of her symptoms.

The rest are the DMARDS which take a long time to cause any noticeable change in the symptoms.
 
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Discussion Starter #9
The answer is E. Prednisolone.
MTX could never be the answer... it modifies the condition but does not provide the early symptomatic relief. i marked it as Naproxen coz as harrison and other IM books give it, a new diagnosed pt. with RA is started on NSAIDS to provide early symptomatic relief and added along with it are other DMARDS such as MTX or Hydroxychloroquine.
 
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