DOC in rheumatoid arthritis is -

Ans. is 'c' i.e., Methotrexate Management protocol for Rheumatoid Arthritis* Before the diagnosis is confirmed and patient is suspecting to have RA - Start one of the NSAIDS. If pain is severe intrarticular corticosteroids is an alternative.* Once diagnosis is confirmed# These days the approach is to start combination of two or three DMARDs.# The combinations most commonly used are1. Methotrexate + Hydroxychloroquine (HCQ)2. Methotrexate + sulfasalazine3. Methotrexate + sulfasalazine + HCQ# If single drug is used - methotrexate is the DOC.# One of the NSAIDs is added initially for symptomatic relief till the effect of DMARDs starts.# Low doses of corticosteroids are also added to decrease the inflammation and recent studies has shown that corticosteroids also retard the disease progression (as DMARDs).# Once the effect of DMARDs starts, NSAIDs & corticosteroids are withdrawn.* Once disease is controlled* Follow up the patient at 3 months, if pt is improving, withdraw 1 drug out of 3 (or 2) drug combination.* Follow up the patient at next 6 week to 3 months and withdraw the second drug (if 3 drugs were used intially, which is usually the protocol).Also know* NSAIDs are used to provide symptomatic relief, they have no effect on the progression of the disease.* DMARDs retard progression of the disease.* Current recommendation is to start DMARDs as soon as the diagnosis of RA is confirmed.* NSAIDs are added initially for symptomatic relief till the effect of DMARDs starts.* Methotrexate is the first choice DMARD and the standard treatment for most of the patients.* Hydroxychloroquine is probably the safest DMARD for use during pregnancy.