A 74-year-old man comes to the physician for a follow-up examination. He has a 3-month history of severe pain and swelling of the metacarpophalangeal joints, wrists, elbows, and knees. Previous treatment with aspirin,methotrexate, and naproxen has not relieved his symptoms. He has one kidney. Physical examination shows no other abnormalities. His serum rheumatoid factor is increased, and serum creatinine concentration is 3.8 mg/dL. Which of the following is the most appropriate pharmacotherapy?
(D) Gold salts
Correct answer : (C) Etanercept
Etanercept (TNF alpha antagonist) is the appropriate treatment. The other drugs mentioned cannot be given as his renal function is compromised.