Orthopaedic Nurses Certification Board (ONCB) Metabolic/Inflammatory/Tumors Practice Exam

Which medication should a patient with reactive arthritis avoid while taking due to potential risks?

1. Indomethacin (Indocin®)

2. Corticosteroid eye drops

3. Topical skin cream

4. Methotrexate (Rheumatrex®)

The correct answer is: Methotrexate (Rheumatrex®)

Patients with reactive arthritis should be cautious with methotrexate (Rheumatrex®) due to its significant side effect profile and the potential for serious risks. Methotrexate is a disease-modifying antirheumatic drug (DMARD) commonly used for various autoimmune and inflammatory conditions, including rheumatoid arthritis and severe cases of reactive arthritis. However, it can cause hepatotoxicity, pulmonary toxicity, and bone marrow suppression. In the case of reactive arthritis, many patients experience milder forms of the condition that may respond adequately to non-steroidal anti-inflammatory drugs (NSAIDs) or other treatments without needing the more intense management that methotrexate entails. Using methotrexate can complicate the treatment due to its risks and the necessity for regular monitoring of liver enzymes and blood counts during treatment. Thus, unless there is a clear indication for its use or if the patient's condition is severe and unresponsive to safer alternatives, avoiding methotrexate minimizes unnecessary exposure to these risks. This is particularly crucial in a reactive arthritis case, where simpler and safer therapies might suffice.