A 25-year-old woman develops painful swelling of both hands and wrists. She is also very stiff in the morning. Physical examination reveals erythema, swelling and joint line tenderness of the proximal interphalangeal, MCP, and wrists joints. Her RF is positive, ANA is negative, and x-rays of the hands show early erosive joint changes. Which of the following medications is most likely to prevent progression of disease?
A 25-year-old woman develops painful swelling of both hands and wrists. She is also very stiff in the morning. Physical examination reveals erythema, swelling and joint line tenderness of the proximal interphalangeal, MCP, and wrists joints. Her RF is positive, ANA is negative, and x-rays of the hands show early erosive joint changes. Which of the following medications is most likely to prevent progression of disease?
💡 Explanation
## **Core Concept**
The patient's symptoms and test results are indicative of **Rheumatoid Arthritis (RA)**, a chronic autoimmune disorder characterized by symmetric polyarthritis, morning stiffness, and erosive joint changes. The presence of **rheumatoid factor (RF)** and **early erosive joint changes** on x-ray are key diagnostic features. The goal of treatment in RA is to prevent disease progression, reduce inflammation, and improve quality of life.
## **Why the Correct Answer is Right**
The correct answer, **Methotrexate**, is a **disease-modifying antirheumatic drug (DMARD)** that is commonly used as a first-line agent in the treatment of RA. Methotrexate works by inhibiting **dihydrofolate reductase**, which leads to a decrease in DNA synthesis and cell replication, particularly in rapidly dividing cells such as activated lymphocytes. This results in a reduction of inflammation and prevention of joint damage. Methotrexate has been shown to slow disease progression, reduce symptoms, and improve functional ability in patients with RA.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is incorrect because, although it might represent a biologic DMARD, without specifying the drug, it's hard to assess its appropriateness. However, biologics like **TNF-alpha inhibitors** are also effective but usually considered after methotrexate or in combination.
- **Option B:** This option is incorrect as it does not specify a medication known for preventing disease progression in RA.
- **Option D:** This option is incorrect because, while **Corticosteroids** can rapidly reduce inflammation and alleviate symptoms, they are not typically used alone for long-term prevention of disease progression due to their side effects.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that early initiation of **DMARDs**, such as methotrexate, in patients with RA can significantly prevent **joint damage** and **disability**. The goal is to achieve **remission** or **low disease activity**, and regular monitoring of disease activity and adjustment of therapy are crucial.
## **Correct Answer:** . Methotrexate
✓ Correct Answer: C. methotrexate
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