TREATMENT. The goals of treatment are to confirm the diagnosis, to stage the extent of the disease, and to begin step-by-step care to reduce pain and inflammation Systemic treatment with oral medication is the treatment of choice Step 1 Define the distribution among joints, esamine for acute synovitis and order rays of the hand(PA and lateral views) Reduce repetitive, fine finger motions and heavy gripping and grasping the work schedule, adding rest periods in between periods of repeti tive handwork. Encourage the patient to remain active, balancing periods of rest with activity Recommend gentle, passive stretching exercises(p. 263) Avoid exposure to vibration(vacuum cleaners, lawn mowers, and tools that vibrate) Offer salicylates extra-strength Tylenol, or an NSAID for moderate disease. Recommend heat to reduce stiffness(warm water, shower, paraffin treatments, and so forth). Minimize the use of narcotics