Because the diagnosis of an inflammatory arthropathy remained in doubt, the methotrexate was also discontinued. The arthritis had come back under control by the time of her return to Kuwait in December. Minimize exposure to prednisone. Reinforce to patient NOT to self-administer prednisone. Distinguish symptoms of osteonecrosis from those of her arthritis.
Inflammatory arthritis is manifested by stiffness, joint swelling and elevated sed rate.
Pain due to osteonecrosis is elicited by movement of the joint, and it generally does not cause joint swelling or elevated sed rate. Continue treatment for osteoporosis. References Campen DH, Kaufman RL, and Beardmore. Candida Septic Arthritis in Rheumatoid Arthritis. A Report and Review of the Literature.