American Board of Internal Medicine (ABIM) Certification Practice Exam

What short-term therapies may be used as a bridge while starting DMARDs for rheumatoid arthritis?

1. Antibiotics or physical therapy

2. NSAID or glucocorticoid therapy

3. Corticosteroids or methotrexate

4. Surgery or alternative medicine

The correct answer is: NSAID or glucocorticoid therapy

While starting Disease-Modifying Antirheumatic Drugs (DMARDs) for rheumatoid arthritis, it is often necessary to manage symptoms and inflammation in the short term. Nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids are commonly used for this purpose. NSAIDs provide symptomatic relief by reducing pain and inflammation, which can help patients feel better while waiting for DMARDs to take effect, as DMARDs typically take weeks to months to show their maximal benefits. Glucocorticoids, such as prednisone, can be used to quickly reduce inflammation and control flare-ups, making them particularly useful in managing active disease. These therapies act as a bridge, allowing for improved patient comfort and function until the DMARDs begin to work effectively. Their use is based on their anti-inflammatory properties and rapid onset of action, which meet the immediate needs of patients who are experiencing pain and joint deterioration due to rheumatoid arthritis. In contrast, the other options do not address the need for short-term symptomatic relief in the same way. Antibiotics or physical therapy do not have a direct impact on the inflammatory process associated with rheumatoid arthritis. Surgery, while valuable for certain cases, is not typically considered a bridge therapy and carries its own