A 45-Year-Old Woman Comes to the Office with Knee Pain

question 1280

Multiple Choice

A 45-year-old woman comes to the office with knee pain.  She has a long history of rheumatoid arthritis affecting the joints of her hands, wrists, and knees.  The patient has mild residual pain and joint stiffness on low-dose methotrexate but has otherwise done well.  Over the past 2 days, the pain in her right knee has been much more severe and was associated with an episode of chills.  Temperature is 38.7 C (101.6 F) , blood pressure is 120/70 mm Hg, pulse is 100/min, and respirations are 18/min.  Physical examination shows mild swelling in the joints of the hands and wrists.  The right knee is red and more swollen than on previous examinations; active and passive range of motion at the right knee is limited due to pain.  After appropriate diagnostic testing, which of the following is most likely to be indicated for this patient's current condition?

• A)Allopurinol
• B)Antibiotics
• C)Anticytokine agent
• D)Colchicine
• E)Glucocorticoids
• F)High-dose methotrexate

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