RT Book, Section
A1 Negm, Ahmed A.
A1 Furst, Daniel E.
A2 Katzung, Bertram G.
SR Print(0)
ID 1148438488
T1 Nonsteroidal Anti-Inflammatory Drugs, Disease-Modifying Antirheumatic Drugs, Nonopioid Analgesics, & Drugs Used in Gout
T2 Basic & Clinical Pharmacology, 14e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9781259641152
LK accesspharmacy.mhmedical.com/content.aspx?aid=1148438488
RD 2024/04/19
AB CASE  STUDYA  48-year-old  man  presents  with  complaints  of  bilateral  morning  stiffness  in  his  wrists  and  knees  and  pain  in  these  joints  on  exercise.  On  physical  examination,  the  joints  are  slightly  swollen.  The  rest  of  the  examination  is  unremarkable.  His  laboratory  findings  are  also  negative  except  for  slight  anemia,  elevated  erythrocyte  sedimentation  rate,  and  positive  rheumatoid  factor.  With  the  diagnosis  of  rheumatoid  arthritis,  he  is  started  on  a  regimen  of  naproxen,  220  mg  twice  daily.  After  1  week,  the  dosage  is  increased  to  440  mg  twice  daily.  His  symptoms  are  reduced  at  this  dosage,  but  he  complains  of  significant  heartburn  that  is  not  controlled  by  antacids.  He  is  then  switched  to  celecoxib,  200  mg  twice  daily,  and  on  this  regimen  his  joint  symptoms  and  heartburn  resolve.  Two  years  later,  he  returns  with  increased  joint  symptoms.  His  hands,  wrists,  elbows,  feet,  and  knees  are  all  now  involved  and  appear  swollen,  warm,  and  tender.  What  therapeutic  options  should  be  considered  at  this  time?  What  are  the  possible  complications?