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A 39-year-old wom an com plained to her physician of joint pain that had worsened over the past m onth. The pain was worst in the m orning and prevented her from perform ing her household tasks for at least an hour after waking. She tried ibuprofen three tim es daily for 2 weeks, but relief was poor, and she stopped the m edication because of epigastric pain. The wom an was also su ering from chronic active hepatitis B, currently treated w ith lam ivudine. On physical exam ination, the patient appeared uncom fortable w ith any m ovem ent. Her w rists, m etacarpophalangeal joints, and knees
A 39-year-old wom an com plained to her physician of joint pain that had worsened over the past m onth. The pain was worst in the m orning and prevented her from perform ing her household tasks for at least an hour after waking. She tried ibuprofen three tim es daily for 2 weeks, but relief was poor, and she stopped the m edication because of epigastric pain. The wom an was also su ering from chronic active hepatitis B, currently treated w ith lam ivudine. On physical exam ination, the patient appeared uncom fortable w ith any m ovem ent. Her w rists, m etacarpophalangeal joints, and knees showed bilaterally sym m etrical swelling, tenderness, and warm th. Further exam s con rm ed the diagnosis, and a pharm acotherapy was prescribed. Which of the follow ing drugs would be appropriate for the patient at this tim e? A. Methotrexate B. Aspirin C. Etanercept D. Piperacillin E. Cipro oxacin F. Erythromycin
