A 55-year-old female on methotrexate presents with continuous pain and swelling of bilateral hand joints. What is the best treatment plan for this patient?
Double the dose of methotrexate
Methotrexate + high potency Oral steroids
Methotrexate + Sulphasalazine + Hydroxychloroquine
Stop methotrexate and sta Monotherapy with anti-TNF- drugs
The image shows subluxation at first MCP of both hands with deformity in fingers on right hand. Coupled with the clinical history, the diagnosis is Z line deformity of Rheumatoid ahritis with persistent disease activity. She is already on methotrexate and should now be put on triple therapy of methotrexate with sulphasalazine and hydroxychloroquine. Choice A will lead to higher side effects of methotrexate. Choice B will lead to increased incidence of osteoporosis. Choice D: anti- TNF drugs are used not alone but in conjunction with methotrexate. Failure to achieve remission with methotrexate calls for change in DMARD therapy as follows: 1. Oral triple therapy (Methotrexate + sulphasalazine + Hydroxychloroquine) 2. Methotrexate and leflunomide 3. Methotrexate and biologicals like ceolizumab
Rheumatoid Ahritis