Question of the Week # 324

324)  A 45 year old woman with history of Rheumatoid Arthritis presents to the emergency room increasing pain and swelling in her joints. She reports progressively increasing pain and stiffness of her bilateral wrist joints over the past two weeks. She now developed rapidly increasing pain and swelling in her right knee which prompted this Emergency Room visit. Her medications include Ibuprofen and Methotrexate. On examination, she is afebrile. There is mild swelling and tenderness in bilateral wrist joints. Right knee is warm, swollen and tender. Flexion and extension of the right knee  are severely painful.  Laboratory investigations are as follows:

WBC 9.0k/µl

Differential: Neutrophils 65%, Lymphocytes 24%, Monocytes 7%

Hemoglobin 11.5 g/dL ( Normal = 13.0 to 16.5 gm%),

Mean cell volume (MCV)  84  fL

Platelet count 510k/µl ( Normal 180 to 350k⁄μl )

ESR : 70 mm/hr

Which of the following is the most appropriate next step in management?

A)  Pulse Methyl Prednisolone

B)  Oral Prednsione

C) Arthrocentesis

D) Discontinue Methotrexate and start Infliximab

E) Intra-articular Glucocorticoids

9 Responses

  1. Answer is A; Pulse Methyl Prednisolone

  2. C

  3. cccccccccccccccccccc

  4. C….

  5. ccc

  6. D

  7. C) Arthrocentesis

  8. C…..Always look for septic arthritis in the course of reumatoide arthritis

  9. flare-up of RA is treated with oral prednison.
    when multiple joints affected ( not only knee for you to poke with artrocentesis) and no fever no reason to suspect else. go for treatment. If pain eccur after interuption CST add TNF inhib

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