Rheumatoid Arthritis Case Review: 53-year-old Female RA Patient Who Is Biologic Naive

November 20, 2020
Rheumatology Network Editorial Staff

Roy M. Fleischmann, M.D., 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.