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Article
April 22, 1988

Treatment of the Patient With Rheumatoid Arthritis Refractory to Standard Therapy

Author Affiliations

From the Arthritis and Rheumatism Branch, National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Md.

From the Arthritis and Rheumatism Branch, National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Md.

JAMA. 1988;259(16):2446-2449. doi:10.1001/jama.1988.03720160066032
Abstract

SELECTED CASE  AT THE age of 23 years, following a pregnancy, a woman developed severe fatigue, morning stiffness, and marked swelling and tenderness of multiple peripheral joints. On presentation to her physician, she was found to have serum rheumatoid factor in a high titer, an elevated erythrocyte sedimentation rate, and an elevated level of C-reactive protein. Roentgenographic studies revealed diffuse periarticular demineralization without bony erosions. A diagnosis of rheumatoid arthritis was made. During the next three years, the woman, in addition to undergoing physical therapy, was treated without significant or sustained improvement with several nonsteroidal anti-inflammatory drugs, hydroxychloroquine sulfate, gold salts, and penicillamine. In addition, treatment with low-dose prednisone was begun at a dosage of 5 to 10 mg orally per day. Moreover, she received many intra-articular injections of corticosteroids in many of her most troublesome joints to provide transient disease suppression in those joints. Progressive disease and disability were

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