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.