31st January 2024

A 63-year-old lady with rheumatoid arthritis on methotrexate and sulfasalazine presents to A&E with a hot, swollen right wrist. She has a reduced range of movement, a low-grade fever and feels unwell.

A 63-year-old lady with rheumatoid arthritis on methotrexate and sulfasalazine presents to A&E with a hot, swollen right wrist. She has a reduced range of movement, a low-grade fever and feels unwell.

Investigations:

Haemoglobin 135 g/L (115-165)

Mean Cell Volume 78.9fL (80-96)

White Cell Count 13.9 x 10⁹ /L (4.0-11.0)

CRP 65mg/L (<10)

How would you manage this patient?

Select the SINGLE most appropriate option from the list below. Select ONE option only.