A patient has been taking a COX-2 selective NSAID to treat pain associated with a recent onset of RA.The patient tells the primary care NP that the pain and joint swelling are becoming worse.The patient does not have synovitis or extraarticular manifestations of the disease.The NP will refer the patient to a rheumatologist and should expect the specialist to prescribe:

Question

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In mild RA disease,patients are given NSAIDs first for 2 to 3 months,and then either hydroxychloroquine or sulfasalazine is added if the disease does not remit.Methotrexate is a first-line drug for patients with more aggressive symptoms,such as synovitis or extraarticular symptoms.Opioid analgesics are used as adjuncts for pain relief along with DMARDs.

A Patient Has Been Taking a COX-2 Selective NSAID to Treat