ABSTRACT
A 32-year-old woman was attending the rheumatology clinic for review of her rheumatoid arthritis. For the past 3 years, her rheumatoid arthritis had been poorly controlled. She had experienced painful swelling of her hands and feet, and joint stiffness that lasted for 60–90 min each morning. She also felt fatigued and had noticed some unintentional weight loss. She had no other past medical history. Her regular medications included prednisolone 10 mg OD and omeprazole 20mg OD. She had trialled courses of naproxen, methotrexate, sulfasalazine and hydroxychloroquine over the past 2 years, with no significant improvement in her symptoms. She had no known drug allergies. She worked as a journalist, drank 5–10 units of alcohol per week and had never smoked.
