What is the most effective treatment for polyarthritis in a patient with chronic gastritis?
—Thien B. Nguyen, DO, Sugar Land, Tex.

Inflammatory polyarthritis will eventually require a disease-modifying agent, but these are slow-acting. The least gastrotoxic agent is hydroxychloroquine (Plaquenil). Initially, the patient will require an anti-
inflammatory regimen with a COX-2 agent or low-dose steroid (oral or injectable) and simultaneous vigorous therapy of the stomach. Local therapy of the most severely affected joints will include ice packs, rest, and perhaps local intra-articular steroids.
—Jack Waxman, MD (119-16)