A patient who has been diagnosed with rheumatoid arthritis (RA) for 1 month and has genera-lized symptoms is taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) and an oral glucocorticoid
The provider has ordered methotrexate [Rheumatrex]. The patient asks the nurse why methotrexate is necessary since pain and swelling have been well controlled with the other medications. The nurse will tell the patient that: a. a methotrexate regimen can reduce overall costs and side effects of treatment.
b. starting methotrexate early can help delay joint degeneration.
c. starting methotrexate now will help in-crease life expectancy.
d. with methotrexate, doses of NSAIDs can be reduced to less toxic levels.
B
Current guidelines for treatment of RA recommend starting a disease-modifying antirheumatic drug (DMARD) early—within 3 months of diagnosis for most patients—in order to delay joint degeneration. Methotrexate may take up to 3 to 6 weeks to be at therapeutic levels, so NSAIDs and glucocorticoids should be continued until this occurs. Methotrexate is expensive and has more toxic side effects. Patients taking methotrexate have been shown in some data to have de-creased life expectancy. Patients may eventually be able to stop taking NSAIDs altogether.
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