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64799 Medicine

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?

ANaproxen 500 mg twice a day and follow up in 1 month
BMethotrexate 12.5 mg a week with liver function tests in 1 month
CAnti-histone antibodies, anti-DS-DNA, and complement levels
DPrednisone 60 mg a day and follow up in 2 weeks
Medicine
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