Review Question - QID 214335

A 64-year-old woman presents to her primary care physician with severe joint pain in her bilateral hands and wrists. She was initiated on therapy 6 months ago by her previous doctor for which she has been compliant. While the patient initially had improvement in her symptoms, she now has worsening joint pain that is most severe in the morning. Her pain improves throughout the day and with movement. On physical exam, lungs are clear to auscultation and heart sounds are regular. Her hands and wrists are shown in Figure A. Laboratory results are the following:

Leukocyte count: 12,000/mm^3 with normal differential
Creatinine: 0.8 mg/dL
Alkaline phosphatase: 45 U/L
Aspartate aminotransferase (AST): 110 U/L
Alanine aminotransferase (ALT): 120 U/L
Sedimentation rate: 62 mm/hr
C-reactive protein: 3.2 mg/L

Which of the following is most likely to reduce the progression of this patient's condition?