A Puzzling Case: Oral Ulcers in an Older Patient With Rheumatoid Arthritis

Discussion Rheumatoid arthritis is characterized by chronic inflammatory erosive changes in the joints caused by an autoimmune response.9 The disease can occur in any decade of life, but predominantly arises in the third to fourth decade. Treatment of RA is aimed at producing remission or reducing disease activity to a low-disease activity level.10-12 Many pharmacologic options are used to fight the progression of RA. Methotrexate's side effect profile includes nausea, hair loss, gastrointestinal upset, folic acid degradation, and hepatotoxicity10 Health care providers must be mindful of these side effects and monitor for them with routine laboratory work. Comparative effectiveness of biological medicines in rheumatoid arthritis: systematic review and network meta-analysis including aggregate results from reanalysed individual patient data.