A 48-Year-Old Woman Comes to the Physician Because of Pain

question 135

Multiple Choice

A 48-year-old woman comes to the physician because of pain in her hands for the last 6 months.  She also has joint stiffness every morning that lasts several hours.  The patient has no weight loss, fever, chest pain, or back pain.  Examination of her joints shows mild swelling and tenderness of several proximal interphalangeal joints, metacarpophalangeal joints, and both wrists.  There are no skin rashes or mucosal lesions.  No lymph nodes are palpable.
Laboratory results are as follows:

X-ray of the hands reveals periarticular osteopenia and mild erosions of the proximal interphalangeal and metacarpophalangeal joints.  She is started on naproxen and returns for follow-up 2 weeks later with marked improvement in her symptoms.
Which of the following is the best next step in the management of this patient?

• A)Close clinical follow-up
• B)Febuxostat
• C)Infliximab
• D)Methotrexate
• E)Prednisone

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Definitions:

Automatic Response

A pre-set reply or action that is triggered by a specific event or condition, often used in email systems and customer service.

Society

A structured community of people bound together by similar traditions, institutions, or nationality.

Cultural Pluralism

The practice of accepting multiple cultures on their own terms.

Multiple Cultures

The coexistence of diverse cultures within a community or society, each with its own beliefs, traditions, and practices.