•A 43-year-old woman presents with stiffness and pain in her fingers. It takes her about an hour in the morning to be able to use her hands. The symptoms started approximately 3 months ago, and they have gradually worsened. Recently, she also realized that some of her finger joints are swollen. She has a 2-year history of knee pain when climbing stairs. The patient's medical history includes hypertension, hyperlipidemia, and coronary artery disease. (3 g/day), simvastatin (10 mg qh),
• Vital signs are temperature 98.5° F, blood pressure 145/85 mm Hg, pulse rate 80/min, and respiratory rate 20/min. Physical examination is remarkable for swelling around the metacarpophalangeal and proximal interphalangeal joints of the 2nd to 4th fingers bilaterally. There are no skin alterations. X-rays taken of both hands and knees show juxta-articular osteopenia,bone erosions, and loss of articular cartilage. What is the most appropriate initial treatment option?
7th EditionGary A. Thibodeau, Kevin T. Patton 7th EditionJulie S Snyder, Linda Lilley, Shelly Collins 7th EditionJulie S Snyder, Mariann M Harding