jean robert
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A 45 y.o. female presents with swelling and pain of multiple joints.The symptoms started 6-7 months ago and gradually progressed over time.She notes prolonged morning stiffness and significant restriction of her daily activities.
Which of the following drugs would provide the most rapid and complete relief of her symptoms?
a.-Naproxen
b.-Methotrexate
c.-Sulfasalazine
d.-Hydroxychloroquine
e.-Prednisone
f.-Minocycline
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| me007
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b?
Disease-modifyied treatment in RA, pt has not acute severe pain.
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| new_n_lost
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e.-Prednisone agree this is a DMARDs giving her a Methotrexate will have a lot SE give a Steriod n get her to moblize with an antiinflammatory .
Guys any comments.
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| Mikeland
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The point is rapid and complete relief of her symptoms of inflamatory reaction. Drugs for RA must be used for initial manegment a NSAID ( Naproxen)
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| me007
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in acute symptoms in RA - glucocorticoids,
NSAIDS first line in gout
i just not sure that pt's symptoms can be considered as acute, for Mtx it takes few weeks after administration.
but DMARs are Mtx, and TNF alfa inhibitors, not glucocorticoids.
Also glucocort administered for short time in RA.
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| Mikeland
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At Kaplan notes pharma "Drugs for Rheumatoid Arthritis" They sugest as initial management NSAIDs and leve esteroids and DMARDs for continuous teatment. However we know that only the DMARDs slow disease progression. page 244.
My experience as Internist we start with NSAIDs before any drugs and diagnosis in RA. If I wrong let me know.
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| me007
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let see, 6-7 month of gradually progressed desease.
i guess it can't be monotherapy with NSAIDs
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| new_n_lost
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As Internist  Plz We r most of Post Grads. this Aint High School n We all r here to Learn. Period.
For RA DMARDs r the DOCs for the progression n remission of the disease. As a rule Pts given Steroids n AntiInflammatory Drugs to reduce the Swellings n Pain n then the Drugs r started. Streroids n NSAIDs r used as a Bridging therapy.
The Question asks us that wht wud be the most effective way to reduce her restricted movement. the answer can be either Naproxen or Prednisone.
Thats wht i think which can be totally wrong so we will have to see till the Answer is posted.
Edited by new_n_lost on 04/17/07 - 11:07 AM
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"never argue with a fool, they'll bring you down to their level and beat you with experience" FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| Mikeland
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I am sorry if I said thomething wrong. I will not mention it againg. I know that we (all of us) are learning and thats why I am here.
About the Q.
most rapid and complete relief of her symptoms? They are ask the most "RAPID" and complete RELIEF" of the symptoms. I still sugest start with NSAIDs, them right there continue with steroid and prepare the patient for DMARD ( diagnostic and lab test to avoid iathrogenia)
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| Mikeland
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Cost effect could be prednisone, If somebody has the answer. I want to know what is the final one?.
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| new_n_lost
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Wudnt WE All 
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"never argue with a fool, they'll bring you down to their level and beat you with experience" FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| me007
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ok, it more likely prednison as a first line here bcs
pt is suffering, daily activity restricted, everithing is worsening.
just hard to understend, pt had this for monthes, nobody cared
it takes few weeks for Mtx to start work
it takes few days for prednisone to help.
both have tremendous side effects.
but mtx is DMARD while prednisone is not.
but pt is suffering, prednisone is faster. nnl is right.
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| Mikeland
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 I am agree w/both of u now
the answ. is Prednisolone, this Q is really treak Q
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| jean robert
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Guys, the answer is E. It s a UW question,they give the following explanation:
Corticosteroids are potent immunosuppressive and antiinflammatory agents, capable of providing rapid and complete relief in most patients with acute joint swelling and pain.Corticosteroids exert their antiinflammatory effects by inhibiting phopholipase A2 activity which decreases PG and leukotriene synthesis .Corticosteroids also depress the immune response by reducing macrophage phagocytosis and Il-1 secretion.
In patient with acute symptoms, glucocorticoids are typically added for a short period to achieve rapid symptom relief until slower acting disease modifying agents can take effect.
NSAIDs such as Naproxen can also be used to treat acute symptoms. NSAIDs have ONLY antiinflammatory effects; they don t dampen the general immune response.NSAIDs offer less relief of pain and swelling compared to corticosteroids, but cause fewer adverse effects.
Methotrexate(answer b) is the preferred disease modifying treatment for most patients with moderate to severe RA.Methotrexate Treatment produces substantial improvements in disease activity in 60-70% of patients. However, the response typically takes WEEKS to occur.
SULFAZALAZINE,HYDROXYCHLOROQUINE,MINOCYCLINE are sometimes used to treat mild,EARLY,seronegative RA. Severe disease is unlikely to respond to these medications.These drugs don t have antiimflammatory effects but rather work as immunomodulators to modify the disease course.
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