A female repos symmetrical small joint polyahritis for 2 weeks. Labs show rheumatoid factor levels at 1:320 (positive is 1:40) and anti-CCP at 58 units (40 to 59 units are considered strongly positive). An antinuclear antibody test is negative. Labs also reveal positive cytomegalovirus and paravovirus IgG, and negative parvovirus IgM. The ESR is 62 mm/hour. What is the appropriate next step in the management of this patient?
A female repos symmetrical small joint polyahritis for 2 weeks. Labs show rheumatoid factor levels at 1:320 (positive is 1:40) and anti-CCP at 58 units (40 to 59 units are considered strongly positive). An antinuclear antibody test is negative. Labs also reveal positive cytomegalovirus and paravovirus IgG, and negative parvovirus IgM. The ESR is 62 mm/hour. What is the appropriate next step in the management of this patient?
💡 Explanation
A female repos symmetrical small joint polyahritis for 2 weeks. Labs show rheumatoid factor levels at 1:320 (positive is 1:40) and anti-CCP at 58 units (40 to 59 units are considered strongly positive). An antinuclear antibody test is negative. Labs also reveal positive cytomegalovirus and paravovirus IgG, and negative parvovirus IgM. The ESR is 62 mm/hour. What is the appropriate next step in the management of this patient?
✓ Correct Answer: B. Methotrexate 12.5 mg a week with liver function tests in 1 month
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