Rosh Emergency Medicine Practice Test

What is the appropriate initial management for a suspected case of rheumatoid arthritis in a patient with bilateral wrist pain?

1. A. Calcium, vitamin D, and exercise

2. B. NSAIDs and gene testing

3. C. NSAIDs and strengthening exercises

4. D. Prednisone and rheumatology referral

The correct answer is: D. Prednisone and rheumatology referral

In a suspected case of rheumatoid arthritis (RA), especially when a patient presents with bilateral wrist pain, the appropriate initial management focuses on both alleviating symptoms and facilitating further evaluation by a specialist. Prednisone, a corticosteroid, is commonly used in the initial management of RA due to its anti-inflammatory properties, which can help quickly reduce inflammation and pain, providing symptomatic relief while further diagnostic clarification is pursued. Additionally, a referral to a rheumatologist is vital for comprehensive management of rheumatoid arthritis. RA is a complex autoimmune condition that often requires specialized care for long-term disease management, including potentially starting disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate or biologics. Other options, such as over-the-counter NSAIDs, while they may provide pain relief, are not typically sufficient as an initial monotherapy in suspected RA cases where disease progression needs to be managed proactively. Strengthening exercises can be beneficial, but they would generally be incorporated later in the management plan, once the acute inflammation is controlled. Similarly, while calcium and vitamin D are important for overall health, they do not address the immediate inflammatory process associated with RA and would not be considered sufficient therapy in this context.