RT Book, Section A1 Shagroni, T. A1 Cazares, A. Ramirez A1 Kim, J.A. A1 Furst, Daniel E. A2 Katzung, Bertram G. A2 Vanderah, Todd W. SR Print(0) ID 1176467346 T1 Nonsteroidal Anti-Inflammatory Drugs, Disease-Modifying Antirheumatic Drugs, Nonopioid Analgesics, & Drugs Used in Gout T2 Basic & Clinical Pharmacology, 15e YR 2021 FD 2021 PB McGraw-Hill PP New York, NY SN 9781260452310 LK accesspharmacy.mhmedical.com/content.aspx?aid=1176467346 RD 2024/03/28 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 (bid). After 1 week, the dosage is increased to 440 mg bid. 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 bid, 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. He is given oral methotrexate weekly and his disease decreases by about 20%, but he continues to have multiple tender and swollen joints and morning stiffness that lasts 2 hours. What therapeutic options should be considered at this time? What are the possible complications?