A 26-Year-Old Woman Is Evaluated for Joint Pain Affecting the Elbows

A 26-year-old woman is evaluated for joint pain affecting the elbows, knees, and ankles for the past month.  She has also experienced a dry cough and mild shortness of breath over the last 6 months.  She is sexually active and takes oral contraceptives.  Temperature is 37.2 C (99 F) , blood pressure is 120/70 mm Hg, pulse is 84/min, and respirations are 16/min.  On physical examination, the lungs are clear to auscultation.  There is mild swelling and tenderness of the elbows, knees, and ankles.  The lower extremities are tender to palpation and have scattered erythematous nodules.  Chest x-ray reveals lung nodules and hilar fullness.  Transbronchial biopsy shows large epithelioid cells, occasional giant cells, and no areas of necrosis.  Which of the following pharmacotherapies is most appropriate for the initial treatment of this patient?

A) Ceftriaxone
B) Doxycycline
C) Etanercept
D) Penicillin
E) Prednisone

Correct Answer:

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