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| * neuroq11 |
| | #531415 |
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A 48-year-old man is evaluated for a 6-month history of intermittent fevers to 38.3 °C (101 °F) and a 9.1-kg (20-lb) weight loss over the past year. He has had several episodes of pain, warmth, and swelling in his wrists, knees, and ankles during the past year. He also has had persistent stiffness and mild swelling of the metacarpophalangeal joints of both hands. Two episodes of posterior uveitis several months ago were treated successfully with corticosteroids, and he has occasional transient diplopia. He takes acetaminophen and naproxen for his joint pain.
On physical examination, temperature is 37.9 °C (100.3 °F). He has left lateral gaze nystagmus, and there is no lymphadenopathy. His arms and legs are thin, multiple metacarpophalangeal joints are swollen but nontender, and he has temporal muscle wasting. The peripheral pulses are normal. Neurologic examination is otherwise unremarkable.
On laboratory studies, hemoglobin is 10.2 g/dL (102 g/L) and erythrocyte sedimentation rate is 70 mm/h. Radiograph of the hands is normal.
Which of the following is the most appropriate next step in this patient's management?
1 anti DNA antibody essay
2 sural nerve biopsy
3 temporal artery biopsy
4 small bowel biopsy
5 bone marrow biopsy |
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