Clinical Crossroads
January 26, 2000

A 55-Year-Old Woman With Rheumatoid Arthritis

Author Affiliations

Author Affiliation: Dr Goldring is Associate Professor of Medicine, Harvard Medical School, and Chief of Rheumatology, Beth Israel Deaconess Medical Center and New England Baptist Hospital, Boston, Mass.


Clinical Crossroads Section Editor: Margaret A. Winker, MD, Deputy Editor.

JAMA. 2000;283(4):524-531. doi:10.1001/jama.283.4.524

DR PARKER: Mrs J is a 55-year-old woman with moderately severe rheumatoid arthritis (RA) that was diagnosed in 1985 after several years of intermittently swollen and painful joints. Due to her illness, she retired from her profession as a restaurateur. She still experiences daily pain in her joints and is facing surgery on her feet. She is married, lives in the Boston suburbs, and has managed care insurance.

Mrs J first noted pain and swelling in her wrists and knees. Later, she experienced morning stiffness, pain, and disfigurement of her hands and feet. After years of symptoms, she was referred to a rheumatologist who made the diagnosis of RA. She did not have adequate clinical responses to oral or intramuscular gold, methotrexate, penicillamine, hydroxychloroquine sulfate, or cyclosporine, mostly because of adverse effects. She took minocycline for 3 months, allowing her to taper her prednisone dosage, but developed yeast infections. Mrs J's arthritis responds "magically" to prednisone, but she dislikes the adverse effects, including cushingoid appearance, weight gain, and diabetes. She describes feeling "run-down" when she tries to taper the prednisone regimen.

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