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?
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
Double the dose of methotrexate
Methotrexate + high potency Oral steroids
Methotrexate + Sulphasalazine + Hydroxychloroquine
Stop methotrexate and sta Monotherapy with anti-TNF- drugs
Rheumatoid Ahritis