Page 656 - Basic _ Clinical Pharmacology ( PDFDrive )

36 Nonsteroidal
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Anti-Inflammatory

Drugs, Disease-Modifying

Antirheumatic Drugs,

Nonopioid Analgesics,

& Drugs Used in Gout

Ahmed A. Negm, MD, & Daniel E. Furst, MD

C ASE STUD Y

A 48-year-old man presents with complaints of bilateral morning twice daily. His symptoms are reduced at this dosage, but he com-
stiffness in his wrists and knees and pain in these joints on exercise. plains of significant heartburn that is not controlled by antacids.
On physical examination, the joints are slightly swollen. The rest He is then switched to celecoxib, 200 mg twice daily, and on this
of the examination is unremarkable. His laboratory findings are regimen his joint symptoms and heartburn resolve. Two years
also negative except for slight anemia, elevated erythrocyte sedi- later, he returns with increased joint symptoms. His hands, wrists,
mentation rate, and positive rheumatoid factor. With the diagnosis elbows, feet, and knees are all now involved and appear swollen,
of rheumatoid arthritis, he is started on a regimen of naproxen, warm, and tender. What therapeutic options should be considered
220 mg twice daily. After 1 week, the dosage is increased to 440 mg at this time? What are the possible complications?

A CR ON Y MS
AS Ankylosing spondylitis PsA Psoriatic arthritis
COX Cyclooxygenase PJIA Polyarticular juvenile idiopathic arthritis
DMARD Disease-modifying antirheumatic drug RA Rheumatoid arthritis
IL Interleukin SJIA Systemic juvenile idiopathic arthritis
JIA Juvenile idiopathic arthritis SLE Systemic lupus erythematosus
NSAID Nonsteroidal anti-inflammatory drug TNF Tumor necrosis factor
OA Osteoarthritis

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