A 65-Year-Old Man Comes to the Emergency Department with a 3-Day

A 65-year-old man comes to the emergency department with a 3-day history of headaches localized to the right temporal region.  The headaches are accompanied by intermittent blurring of vision in both eyes.  He has also felt fatigued for the past week, with stiffness in his shoulders and hips.  On examination, temperature is 37.5 C (99.5 F) .  There is tenderness on palpation of the right temporal region with enlargement of the underlying artery, as shown in the exhibit. 

Funduscopic examination reveals edematous optic discs in both eyes.  The patient has limited active abduction of the shoulder joints bilaterally.  Laboratory studies show an erythrocyte sedimentation rate of 115 mm/hr.  Which of the following is the most important mediator of this patient's current condition?

A) Antibodies to myeloperoxidase
B) Antibodies to proteinase-3
C) B cell-activating factor
D) Interleukin-6
E) Matrix metalloproteinase

Correct Answer:

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