When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate. the patient tells the nurse, "my arthritis isn't that bad yet. the side effects of methotrexate are worse than the arthritis." the most appropriate response by the nurse is:
a. "you have the right to refuse to take the methotrexate."
b. "methotrexate is less expensive than some of the newer drugs."
c. "it is important to start methotrexate early to decrease the extent of joint damage."
d. "methotrexate is effective and has fewer side effects than some of the other drugs."

c. "It is important to start methotrexate early to decrease the extent of joint damage."

Explanation:

Rheumatoid arthritis(RA) is an autoimmune disease in which our immune system attacks our own cells including joints. Over time this disease causes the inflammation of joints, bone erosion, and joint deformity.

Methotrexate is the most popular and the most effective drug used against RA. It decreases immune system activity and reduces the pain and swelling of joints. So starting methotrexate early is important to reduce the damage of joints by RA.  

Therefore the most appropriate response by the nurse is c.

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