A patient who has been diagnosed with rheumatoid arthritis for 1 ...

[colton]

A patient who has been diagnosed with rheumatoid arthritis for 1 month and has generalized symptoms is taking high-dose NSAIDs and an oral glucocorticoid. The provider has ordered methotrexate (Rheumatrex).
 
  The patient asks the nurse why methotrexate is necessary since pain and swelling have been well controlled with the other medications. The nurse will tell the patient that:
  a. a methotrexate regimen can reduce overall costs and side effects of treatment.
  b. starting methotrexate early can help delay joint degeneration.
  c. starting methotrexate now will help increase life expectancy.
  d. with methotrexate, doses of NSAIDs can be reduced to less toxic levels.

Question 2

A patient who has been taking a glucocorticoid for several months arrives in the clinic. The nurse notes that the patient's cheeks appear full and that a prominent hump of fat is present on the upper back.
 
  The nurse will ask the provider to order which test(s)?
  a. Liver function tests
  b. Serum electrolytes
  c. Tuberculin skin test
  d. Vitamin D levels

[tranoy]

Answer to Question 1

ANS: B
Current guidelines for treatment of RA recommend starting a DMARD earlywithin 3 months of diagnosis for most patientsin order to delay joint degeneration. Methotrexate may take up to 3 to 6 weeks to be at therapeutic levels, so NSAIDs and glucocorticoids should be continued until this occurs. Methotrexate is expensive and has more toxic side effects. Patients taking methotrexate have been shown in some data to have decreased life expectancy. Patients may eventually be able to stop taking NSAIDs altogether.

Answer to Question 2

ANS: B
This patient shows signs of iatrogenic Cushing's syndrome, which may include serum electrolyte disturbances; therefore, the electrolyte levels should be monitored. Liver function tests, tuberculin skin testing, and vitamin D levels are not indicated.

[colton]

Excellent

[yeungji]

Thanks for the timely response, appreciate it