a good question

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Posted by mrk from IP 70.20.107.236 on September 03, 2012 at 08:19:57:

A 45-year-old woman comes to the physician because of progressive weakness for several months. At first, she
became aware of increasing difficulty in climbing stairs, then lifting objects above head level. In the past week, the
muscles of the shoulder girdle have become sore. She has had fever up to 38.5 C (101.3 F). On examination,
proximal muscles of the upper and lower extremities are somewhat tender to palpation but not atrophic. There is
periorbital edema associated with a purple discoloration of the upper eyelids. Scaly erythematous patches are seen on
the dorsal aspect of hands and fingers. Laboratory studies show:

Hemoglobin.............................................13.2 g/dL

Leukocyte count......................................9300/mm3

Creatine kinase.......................................2550 U/L

Erythrocyte sedimentation rate (ESR)......22 mm/hr

Antinuclear antibody (ANA) titer............Positive at 1:1280

Rheumatoid factor..................................Positive at 1:512

A biopsy of the deltoid muscle shows atrophy of muscle fibers and interstitial lymphocytic infiltration. Which of the
following is the most appropriate treatment at this time?


A. Azathioprine

B. Methotrexate

C. Nonsteroidal anti-inflammatory drugs (NSAIDs)

D. Plasma exchange

E. Prednisone

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