A 44-year-old woman comes to the physician because of progressive pain and stiffness in her hands and wrists for the past several months. Her hands are stiff in the morning; the stiffness improves as she starts her chores. Physical examination shows bilateral swelling and tenderness of the wrists, metacarpophalangeal joints, and proximal interphalangeal joints. Her range of motion is limited by pain. Laboratory studies show an increased erythrocyte sedimentation rate. . Following initial diagnostic testing, a multidrug treatment regimen is started. Soon after treatment begins, she develops painful mouth ulcers and nausea. Liver function tests show new aspartate transaminase and alanine transaminase elevations. Which of the following medications is most likely responsible for the adverse effects seen in this patient?

Question

A 44-year-old woman comes to the physician because of progressive pain and stiffness in her hands and wrists for the past several months. Her hands are stiff in the morning; the stiffness improves as she starts her chores. Physical examination shows bilateral swelling and tenderness of the wrists, metacarpophalangeal joints, and proximal interphalangeal joints. Her range of motion is limited by pain. Laboratory studies show an increased erythrocyte sedimentation rate. .  Following initial diagnostic testing, a multidrug treatment regimen is started.  Soon after treatment begins, she develops painful mouth ulcers and nausea.  Liver function tests show new aspartate transaminase and alanine transaminase elevations.  Which of the following medications is most likely responsible for the adverse effects seen in this patient?

Quizplus · Accepted Answer

Eductional Objective: Methotrexate is the preferred disease-modifying treatment for patients with moderate to severe rheumatoid arthritis.  Significant adverse effects include stomatitis, bone marrow suppression, and liver function abnormalities.

A 44-Year-Old Woman Comes to the Physician Because of Progressive