A 31-Year-Old Primigravida Comes to the Office Seeking Advice Regarding

A 31-year-old primigravida comes to the office seeking advice regarding her pregnancy.  She discovered that she was pregnant approximately a week ago.  The patient was diagnosed with systemic lupus erythematosus 8 months ago and was started on hydroxychloroquine.  Her initial clinical features included fatigue, pain and swelling of the finger joints, and facial rash.  Her symptoms have subsided with therapy.
The patient has a positive antinuclear antibody test with a 1:640 titer in a homogeneous pattern.  Liver function tests, serum creatinine, complete blood count, and differential are normal.  Urinalysis shows trace protein and 1-2 red blood cells/hpf.  Anti-double-stranded DNA antibodies are positive at 1:120 titer, and anti-Ro/SSA and anti-La/SSB antibodies are negative.  Complement levels are normal.
Which of the following is the best next step in management of this patient?

A) Check antiphospholipid antibodies
B) Check erythrocyte sedimentation rate and rheumatoid factor
C) Discontinue hydroxychloroquine
D) Re-check antinuclear antibody titer
E) Start methotrexate

Correct Answer:

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