What medication can be prescribed for a patient with suspected rheumatoid arthritis (RA) and unbearable pain while awaiting a rheumatology appointment?

From the Guidelines

For a patient with suspected rheumatoid arthritis and unbearable pain awaiting rheumatology consultation, the most appropriate medication to prescribe is prednisone, as it can provide significant pain relief and reduce inflammation. The use of prednisone is supported by the EULAR recommendations for the management of early arthritis, which suggest that systemic glucocorticoids, such as prednisone, can reduce pain and swelling and should be considered as a temporary adjunct to the DMARD strategy 1. Additionally, the 2016 update of the EULAR recommendations for the management of early arthritis also supports the use of systemic glucocorticoids as a temporary adjunctive treatment to reduce pain, swelling, and structural progression 1. Some key points to consider when prescribing prednisone include:

• Starting with a low dose, such as 5-10mg daily, and tapering as possible
• Monitoring for gastrointestinal side effects and considering the addition of a proton pump inhibitor if necessary
• Avoiding the initiation of disease-modifying antirheumatic drugs before diagnosis confirmation
• Advising the patient to rest affected joints during flares while maintaining gentle range of motion exercises, and to apply cold packs to reduce inflammation in acutely swollen joints. It's also important to note that methotrexate is considered the anchor drug for the treatment of rheumatoid arthritis, but it should be initiated by a rheumatologist after diagnosis confirmation 1. In contrast, hydrocodone is not a recommended first-line treatment for rheumatoid arthritis, and gold compounds are no longer commonly used due to their potential side effects and the availability of more effective treatments.

From the FDA Drug Label

Adult Rheumatoid Arthritis: Recommended Starting Dosage Schedules Single oral doses of 7. 5 mg once weekly.† Divided oral dosages of 2.5 mg at 12 hour intervals for 3 doses given as a course once weekly. Therapeutic response usually begins within 3 to 6 weeks and the patient may continue to improve for another 12 weeks or more.

The most appropriate medication that can be prescribed for a patient with suspected rheumatoid arthritis (RA) and unbearable pain while awaiting a rheumatology appointment is Methotrexate or Prednisone.

• Methotrexate is a disease-modifying antirheumatic drug (DMARD) that can help reduce inflammation and slow down disease progression in RA.
• Prednisone is a corticosteroid that can help reduce inflammation and relieve pain quickly. However, the provided drug label does not contain information about Prednisone or Hydrocodone. Gold compounds are also used to treat RA, but the provided label does not mention them. It's essential to note that Methotrexate may take several weeks to start working, so it may not provide immediate pain relief. In contrast, Prednisone can provide faster pain relief, but its long-term use can have significant side effects. The nurse practitioner should consider the patient's overall health, medical history, and current symptoms when deciding which medication to prescribe 2.

From the Research

Medication Options for Rheumatoid Arthritis

The following medications can be considered for a patient with suspected rheumatoid arthritis (RA) and unbearable pain while awaiting a rheumatology appointment:

• Prednisone: This is a corticosteroid that can help reduce inflammation and relieve pain in the short term 3.
• Methotrexate: This is a disease-modifying antirheumatic drug (DMARD) that is commonly used as a first-line treatment for RA. It can help reduce pain, swelling, and joint damage 3, 4, 5, 6, 7.
• Gold compounds: These are another type of DMARD that can be used to treat RA, although they are less commonly used today due to the availability of more effective and safer treatments 3, 4.
• Hydrocodone: This is an opioid pain medication that can be used to relieve severe pain, but it is not a primary treatment for RA and should be used with caution due to the risk of addiction and other side effects.

Considerations for Medication Choice

When choosing a medication for a patient with suspected RA, it's essential to consider the following factors:

• The patient's medical history and current symptoms
• The potential benefits and risks of each medication
• The patient's preferences and values
• The availability of other treatment options, such as physical therapy and lifestyle modifications

Evidence-Based Recommendations

Based on the available evidence, methotrexate is a recommended first-line treatment for RA, either as monotherapy or in combination with other DMARDs or biologic agents 3, 4, 5, 6, 7. Prednisone can be used as a short-term bridge therapy to relieve severe pain and inflammation while awaiting a rheumatology appointment 3. Gold compounds and hydrocodone are not recommended as first-line treatments for RA due to their potential side effects and limited efficacy compared to other available treatments.