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A 53-Year-Old Seamstress Comes to the Physician with Pain and Intermittent

question 278

Multiple Choice

A 53-year-old seamstress comes to the physician with pain and intermittent swelling in her fingers for the past 3 years. Symptoms involve primarily the distal interphalangeal joints and occur after she sews. A year ago, she was hospitalized with upper gastrointestinal bleeding and was found to have erosive gastritis and a duodenal ulcer. Her other medical problems include hypertension, type 2 diabetes mellitus, and fatty liver. Her current medications are glipizide, sitagliptin, lisinopril, and amlodipine.
Her blood pressure is 133/70 mm Hg and pulse is 78/min. Her BMI is 26 kg/m². Her hands appear as shown below. There is bony swelling and tenderness of several distal interphalangeal joints. The remainder of the examination is within normal limits.

Laboratory results are as follows:

Liver function tests are within normal limits.
Which of the following is the most appropriate treatment for this patient?

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Definitions:

Precedent

An earlier event, decision, or action that is regarded as an example or guide to be considered in subsequent similar circumstances.

Judiciary

The system of courts that interprets and applies the law in the name of the state, overseeing legal disputes and upholding the rule of law.

Gibbons v. Ogden

A landmark Supreme Court case in 1824 that clarified the federal government's power to regulate interstate commerce.

Concurring Opinion

A separate judicial opinion that agrees with the court's conclusion but differs on the reasoning or principles behind the decision.