A 38 yr old female patient was diagnosed for seropositive RA a year ago, she was on Hydroxychloroquine 400mg OD along with NSAIDs PRN... And within the period of 1yr, she was thrice under prednisone 5mg for 5 weeks which was tapered. Now, her symptoms are as follows: Morning stiffness present in both the hands. Pain in MCPjt, lt elbow jt. And tiredness. On her visit to a rheumatologist, her lab result except Hb is low 9 and ESR is 111, everything is WNL. Now the question here is the consultant wants to start methotrexate.
As the patient is planning for the pregnancy she refuses. But still, the doctor wants to start biologics which is safe in pregnancy. I would like to suggest sulphasalazine instead of biologic. Why shift directly to biologics? Please suggest your valuable advice. The patient does not have any medical past history.
