Case-Based Perspectives in Rheumatology: Roy M. Fleischmann, MD

Roy M. Fleischmann, MD, clinical professor of medicine at the University of Texas Southwestern Medical Center, assess a case of a 53-year-old woman with rheumatoid arthritis.

Case: Rheumatoid arthritis (RA) active disease in an adult female patient with inadequate response to methotrexate.

Initial Presentation and Treatment:

  • A 53-year-old woman was diagnosed with RA approximately 7 years ago.
    • Confirmed by anti-cyclic citrullinated peptide testing
  • Following diagnosis, she received methotrexate at 10 mg/week, which was escalated to 25 mg/week over time
    • She received modified-release prednisone 5 mg/day in the evenings
    • She has not received a biological DMARD

Subsequent Treatment and Follow-up:

  • On a scale of 0 to 100 mm by visual analog scale, PhGA is 64, the PtGA is 62, and pain is 63.
  • DAS28-CRP is 5.8, DAS28-ESR is 6.5, and hs-CRP is 20 mg/L
  • Lab measures are normal for neutrophil, lymphocyte, hemoglobin, and liver enzyme counts
  • The patient went on to receive upadacitinib at 15 mg/day.
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