A Hemophiliac patient has rheumatoid arthritis. Which drug might be prescribed to relieve the pain?
**Core Concept**
The patient is a hemophiliac with rheumatoid arthritis, requiring pain management while considering the risk of bleeding due to their bleeding disorder. This situation necessitates the use of analgesics that have a low risk of exacerbating the bleeding tendency.
**Why the Correct Answer is Right**
The correct answer is a nonsteroidal anti-inflammatory drug (NSAID) like diclofenac. NSAIDs are effective in relieving pain and inflammation in rheumatoid arthritis. They work by inhibiting cyclooxygenase (COX) enzymes, which are responsible for the production of prostaglandins. Prostaglandins contribute to pain and inflammation in rheumatoid arthritis. Since NSAIDs do not significantly affect platelet function or aggregation, they are considered safe for use in patients with bleeding disorders like hemophilia.
**Why Each Wrong Option is Incorrect**
**Option A:** Corticosteroids like prednisolone are not the first choice for pain management in rheumatoid arthritis and can actually increase the risk of bleeding due to their effect on platelet function and bone metabolism.
**Option B:** Narcotics like morphine can be used for pain management but are not the preferred choice due to their potential for dependence and the risk of exacerbating bleeding in hemophiliacs.
**Option C:** Disease-modifying antirheumatic drugs (DMARDs) like methotrexate are not analgesics and are used to modify the disease process in rheumatoid arthritis; they do not provide immediate pain relief.
**Clinical Pearl / High-Yield Fact**
When managing pain in patients with bleeding disorders, it's essential to weigh the benefits of analgesia against the risk of bleeding. NSAIDs like diclofenac are a good starting point due to their efficacy and safety profile in this context.
**Correct Answer: C. Diclofenac**