M​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​r. D, an elderly male, has been diagnosed with rheumatoid arthritis. When the disease is exacerbated, the last three fingers on his right hand become painful, inflamed, and red. No other joints seem to be involved at this time. Mr. D writes books for a living and enjoys knitting and dancing as hobbies, which are activities that are made difficult due to his arthritis. Mr. D has been treating the pain on his own with acetaminophen. He also takes daily buffered aspirin and multivitamins as prescribed by Dr. S for his cardiovascular health. It is noted that Mr. D has a sulfa allergy. Today, Dr. S and you are making a medical house call to examine Mr. D’s hand. Discuss: 1. Mr. D tells you he has been taking acetaminophen for his arthritis, however “the acetaminophen doesn’t seem to be working very well for my arthri​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​tis pain”. Explain to Mr. D why an anti-inflammatory medication such as an NSAID would work best for this condition and suggest an oral NSAID that Mr. D can use to treat his arthritis. Include the dose range and frequency recommended from your textbook in your answer. 2. You counsel the patient on the precautions and side effects of the medication. How is Mr. D more susceptible to NSAID side effects and what precautions should he take in order to minimize these side effects? 3. Several months later at a follow up visit, Mr. D tells you that he is experiencing epigastric pain. Dr. S determines that Mr. D’s arthritis pain has improved, but he must continue chronic anti-inflammatory therapy. What changes in treatment would you suggest in order to continue anti-inflammatory therapy while also addressing the epigastri​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​c issues?

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