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A 52-Year-Old Man with a History of Rheumatoid Arthritis Comes

question 634

Multiple Choice

A 52-year-old man with a history of rheumatoid arthritis comes to the clinic due to increasing pain and swelling involving several joints over the past 6 weeks. The patient also has fatigue and morning stiffness that can last for hours. He was diagnosed with rheumatoid arthritis 2 years ago after he presented with symmetrical polyarthritis, a high-titer rheumatoid factor, and positive cyclic citrullinated peptide antibodies. Treatment with methotrexate and nonsteroidal anti-inflammatory agents resulted in reduction of joint pain and swelling. At his last visit 3 months ago, the patient had only mild joint pains without any morning stiffness. His other medical problems include hypertension, diverticulosis, and hyperlipidemia.
His temperature is 37.4 C (99.4 F) , blood pressure is 135/82 mm Hg, and pulse is 77/min. Gentle squeezing of his hands and feet evokes pain. Several small joints of the fingers and toes are swollen and tender. There is mild boggy swelling of the left knee. Subcutaneous nodules are seen over the elbows. The remainder of the physical examination is unremarkable.
Laboratory results are as follows:

Which of the following is the best next step in management of this patient?

Definitions:

Growth Rate

The rate at which the amount, value, or size of something increases over a particular period of time.

Total Fertility Rate

The average number of children that would be born to a woman over her lifetime, given current age-specific fertility rates.

Demographic Data

Information collected about populations, such as age, race, gender, income, and education, used to identify and analyze population trends.

Mexico

A country in the southern portion of North America, known for its rich cultural heritage, diverse landscapes, and complex history.