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pain in metacarpophalangeal joints & metatarsophalangeal joint with ANA 1:80, macular erythematous rash on cheecks what dise

Posted by dpg_vision

A 20-year-old school teacher comes in with symmetrical pain and stiffness in the small joints of hands and feet for 10 days.  Two weeks ago, she also noted a macular, erythematous nonpruritic rash on her face (see the picture).  The patient also had feverish feeling, fatigue and myalgia for two days. At the time of presentation, abnormal findings are limited to soft-tissue swelling and slight tenderness around her metacarpophalangeal and metatarsophalangeal joints.

Laboratory studies:

Complete blood count:        Normal

ANA titer;                          1:80

Rheumatoid factor               low activity

Urinalysis:                           Normal

Which of the following next action would be most appropriate ?  

A) Anti-cyclic citrullinated peptide antibodies
B) Antiphospholipid study
C) IgM antibodies against parvovirus B19
D) Anti-double stranded DNA antibodies
E) Cervical gonococcal culture study

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