A 50 year old woman has had rheumatoid arthritis for 3 years and has been taking multiple NSAID’s. She has taken corticosteroids a few times during flare ups. The disease seems to be progressing with stiffness and swelling in her hands and wrists. Examination reveals rheumatoid nodules, synovitis of both wrists and metacarpo-phalangeal joints. This is an indication of an acute exacerbation of rheumatoid arthritis. She is prescribed methotrexate with sulfasalazine and a short course of prednisone.

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation in the joints, primarily affecting the hands and feet. It affects approximately 1% of the population and is more common in women than in men. The disease is progressive, leading to joint destruction, disability, and increased mortality.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage the symptoms of RA, including pain, swelling, and stiffness. These medications provide relief by reducing inflammation and are usually the first-line treatment for mild to moderate RA. However, NSAIDs do not alter the course of the disease or prevent joint damage.

In the case of the 50-year-old woman with RA, her disease seems to be progressing despite NSAID treatment. The presence of stiffness and swelling in her hands and wrists, along with the development of rheumatoid nodules and synovitis in multiple joints, indicates an acute exacerbation of her condition. An exacerbation refers to a flare-up or worsening of symptoms.

To address the worsening symptoms and prevent further joint damage, the woman’s healthcare provider has prescribed a combination therapy consisting of methotrexate and sulfasalazine, along with a short course of prednisone.

Methotrexate is a disease-modifying antirheumatic drug (DMARD) that is commonly used in the treatment of RA. It works by suppressing the overactive immune response that leads to joint inflammation. Methotrexate is considered a first-line therapy for RA due to its efficacy in reducing disease activity and preventing joint damage. It is typically taken once a week in oral or injectable form.

Sulfasalazine is another DMARD that is often used in combination with methotrexate. It works by reducing inflammation and suppressing the immune system. Sulfasalazine may be particularly beneficial for individuals with RA who also have gastrointestinal symptoms, as it can help manage both the joint and gut manifestations of the disease.

Alongside these DMARDs, the woman has also been prescribed a short course of prednisone, which is a corticosteroid. Corticosteroids have potent anti-inflammatory effects and can provide rapid relief of symptoms during flare-ups. However, their long-term use is associated with significant side effects, such as bone loss, weight gain, and increased risk of infections. Therefore, it is generally recommended to use corticosteroids in the lowest effective dose and for the shortest duration possible.

The combination therapy of methotrexate, sulfasalazine, and short-term prednisone aims to address the acute exacerbation of the woman’s RA, manage her symptoms, and slow down the progression of joint damage. Methotrexate and sulfasalazine will work together to suppress the immune response and reduce inflammation, while the short-term use of prednisone will provide immediate relief of symptoms.

It is important to note that the selection and combination of medications for RA should be tailored to each individual’s specific needs and preferences. The choice of DMARDs may depend on factors such as disease severity, response to previous treatments, comorbidities, and potential drug interactions. Close monitoring and regular follow-up with the healthcare provider are crucial to assess the effectiveness and safety of the prescribed therapy and to make any necessary adjustments.

In summary, the acute exacerbation of rheumatoid arthritis in a 50-year-old woman is being managed with a combination therapy of methotrexate, sulfasalazine, and a short course of prednisone. This treatment approach aims to suppress the immune response, reduce inflammation, and provide immediate relief of symptoms. Regular monitoring and follow-up with the healthcare provider are essential to evaluate the effectiveness and safety of the therapy.