A 29-year-old woman develops painful swelling of both hands. She is also very stiff in the morning. Physical examination reveals involvement of the proximal interphalangeal joints and metacarpophalangeal (MCP) joints. Her RF is positive and ANA is negative. Which of the following medications is most likely to improve her joint pain symptoms?

This patient has RA and aspirin or other nonsteroidal agents are effective medications for relieving the signs and symptoms of disease. They do little to modify the course of the disease, however. The new generation of NSAIDs that are more specific inhibitors of cyclooxygenase 2 cause less GI toxicity. Glucocorticoids are very powerful at suppressing signs and symptoms of disease and may alter disease progression. Methotrexate is an important disease modifying drug (DMRD) used to prevent joint destruction. Gold and antimalarials were important DMRDs in the past before the use of methotrexate and newer "biological" agents.