MKSAP: 30-year-old woman with systemic lupus erythematosus

Test your medicine knowledge with theĀ MKSAP challenge, in partnership with theĀ American College of Physicians.

A 30-year-old woman is evaluated during a follow-up visit for systemic lupus erythematosus. She was diagnosed 3 months ago after presenting with pericarditis and arthritis. She was initially treated with prednisone, 40 mg/d, with improvement of her presenting symptoms. The prednisone has been tapered over 3 months to her current dose of 10 mg/d with no recurrence. She also takes vitamin D and a calcium supplement.

On physical examination, vital signs are normal. BMI is 25. Cardiac examination is normal. There is no evidence of arthritis. The remainder of the examination is normal.

Which of the following is the most appropriate next step in treating this patient?

A. Add azathioprine
B. Add hydroxychloroquine
C. Add mycophenolate mofetil
D. Add a scheduled NSAID

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