MKSAP: 23-year-old woman with stiffness and achiness of the hands

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 23-year-old woman is evaluated for a 1-year history of morning stiffness and achiness of the hands as well as Raynaud phenomenon. Two months ago, she experienced a sun-induced rash on the chest and back and patches of discoloration on the hands. On physical examination, temperature is 36.4 °C (97.5 °F), blood pressure is 106/66 mm Hg, pulse rate is 60/min, and respiration rate is 16/min. The lungs are clear. Erythematous, violaceous, clumped papules over the extensor surfaces of the elbows, metacarpophalangeal joints, and proximal interphalangeal joints are present; there are nailfold capillary abnormalities with cuticular hypertrophy. Bilateral proximal upper and lower extremity weakness is noted; there is tenderness of the metacarpophalangeal and proximal interphalangeal joints bilaterally without synovitis. Laboratory studies reveal an erythrocyte sedimentation rate of 82 mm/h, a serum creatine kinase level of 650 units/L, and an antinuclear antibody titer of 1:160 (speckled pattern). Chest radiograph is normal. Electromyography shows muscle irritability without evidence of neuropathy. Which of the following is the most appropriate initial treatment? A: Intravenous immune globulin B: Prednisone C: Prednisone and azathioprine D: Prednisone and methotrexate Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Rheumatology Source Type: blogs