1. RA

2. F.A. is a 25-year-old woman with RA. On diagnosis 1 year ago, F.A. had an RF titer of 1:64, signs and symptoms of inflammation in the joints of both hands, and about 45 minutes of morning stiffness time. She began therapy with methotrexate, and she is presently receiving 15 mg every week, folic acid 2 mg/day, ibuprofen 800 mg 3 times/day, and omeprazole 20 mg/day. At today's clinic visit, F.A. reports a recurrence of her symptoms. Radiographic evaluation of her hand joints shows progression of joint space narrowing and bone erosion.  SOAP  Goal of therapy  Why folic acid and omeprazole are used here?

3. Goal of therapy  The ultimate goal of RA treatment is to induce a complete remission, although this may be difficult to achieve.  The primary objectives are to reduce joint swelling, stiffness, and pain; preserve range of motion and joint function; improve quality of life; prevent systemic complications; and slow destructive joint changes.

4. Why folic acid and omeprazole are used here?  Celecoxib (Celebrex) is a part of a class of NSAIDs called COX-2 inhibitors that has been promoted for the ability to ease pain and inflammation while causing less gastrointestinal damage than traditional NSAIDs do. But a COX-2 drug isn't your only drug option if NSAIDs bother your stomach. In some cases, taking an acid-blocking drug along with your regular NSAID may help.  These drugs include histamine blockers such as cimetidine (Tagamet) and ranitidine hydrochloride (Zantac), or proton pump inhibitors such as lansoprazole (Prevacid) and omeprazole (Prilosec). In other cases, doctors may prescribe a drug called misoprostol (Cytotec) along with your NSAID.

5.  Folic acid is the synthetic form of folate. One study found that RA patients on methotrexate who took folic acid supplements lowered the risk of GI problems and mouth sores by 79 percent.  “Your doctor also may prescribe a folic acid (or folate) vitamin supplement to decrease the chance of side effects”.  “The use of folate supplements (folic and folinic acid) often are given with methotrexate. These are B vitamins and can decrease most side effects during methotrexate treatment”