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A 35-year-old woman comes to the physician with pain and stiffness of her wrists and hand joints for the last several months. Her morning stiffness lasts for more than an hour. She also complains of joint swelling. Her past medical history is significant only for a similar episode a year ago, which resolved with over-the-counter ibuprofen. Joint examination shows mild redness, warmth, swelling, and tenderness in the proximal interphalangeal and metacarpophalangeal joints and wrists. X-rays show periarticular osteopenia and erosions of the proximal interphalangeal and metacarpophalangeal joints. The patient began taking indomethacin, which provides good relief, but symptoms recur if she skips a dose. Which of the following is the most appropriate next step in management of this patient?
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The Peace of Lodi, established in 1454, was a peace agreement that created a balance of power among the Italian city-states of Milan, Naples, and Florence, leading to nearly 40 years of stability in the region.
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A period in Jewish history from 586 to 538 BCE when a number of people from the ancient Kingdom of Judah were captives in Babylonia.
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