A 52-Year-Old Woman with Known Rheumatoid Factor-Positive Rheumatoid Arthritis Comes

A 52-year-old woman with known rheumatoid factor-positive rheumatoid arthritis comes to the physician for routine follow-up.  She currently takes 7.5 mg methotrexate weekly with good response.  She has minimal morning stiffness and good exercise tolerance.  The patient's last flare 2 years ago was treated with a short course of prednisone.  Her other medications include folic acid daily and naproxen occasionally for joint pain.  She has a 30-pack-year smoking history.  There is no family history of cancer or heart disease.
Her blood pressure is 133/82 mm Hg and pulse is 75/min.  Her BMI is 18 kg/m².  There are mild deformities affecting small joints of both hands with no active synovitis.  Lungs are clear to auscultation.  Abdominal examination shows no organomegaly.  There are no skin rashes.
Laboratory results are as follows:

Liver function tests are within normal limits.
Which of the following is the best next step in management of this patient?

A) Bone mineral density testing
B) Left ventricular ejection fraction
C) N-telopeptide
D) Tuberculin skin testing
E) Urine microalbumin excretion

Correct Answer:

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