**Question:** A 25-year-old male presented to the OPD with complaints of pain in B/L knee, hip joints and lower spine. On examination, the joints were found to be erythematous and tender. Note was also made of dark black spots on sclera and ear cailage. X-ray of the affected joints were taken. Which of the following drug has been approved for the above condition: -

A. Methotrexate
B. Prednisolone
C. Hydroxychloroquine
D. Azathioprine

**Core Concept:** Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by symmetric joint involvement, joint pain, swelling, and tenderness. It is a type of autoimmune disease where the body's immune system attacks its own synovial joints, leading to inflammation and destruction of joint cartilage and bone.

**Why the Correct Answer is Right:** The correct answer is D - Azathioprine. Azathioprine is a disease-modifying antirheumatic drug (DMARD) that works by suppressing the immune system, reducing inflammation, and preventing joint damage. It is often used in combination with other immunosuppressive agents to manage severe rheumatoid arthritis cases.

**Why Each Wrong Option is Incorrect:**

A - Methotrexate is another DMARD used for rheumatoid arthritis management. However, it works primarily by inhibiting cell replication, which affects DNA synthesis. It is effective but has higher risk of side effects including gastrointestinal complications, liver dysfunction, and pulmonary toxicity.

B - Prednisolone is a corticosteroid used for reducing inflammation and pain. While it can provide quick relief, its long-term use leads to significant side effects like osteoporosis, weight gain, and adrenal suppression. Therefore, it is not a first-line choice for rheumatoid arthritis treatment.

C - Hydroxychloroquine is an antimalarial drug that reduces inflammation and suppresses the immune system to some extent. However, its mechanism of action is different from DMARDs like Azathioprine. It is less potent and often used alongside DMARDs for better efficacy.

**Clinical Pearl:**

When treating rheumatoid arthritis, a personalized treatment plan involves choosing among DMARDs (like Azathioprine) and corticosteroids (like Prednisolone) based on the severity of the disease, patient's age, and the presence of comorbidities. The combination of DMARDs and corticosteroids is often used for better control of inflammation and disease progression. However, the choice of drugs depends on the patient's overall health condition and disease severity.