A 40-year-old Hispanic woman has diffuse fatigue and arthritis with morning stiffness of at least 2 hours for the last 2 months. Her primary care doctor gave her 20mg of Prednisone with good benefit; however, her symptoms returned after discontinuing the treatment. She now has diffuse extremity edema, joint pains, fatigue, and difficulty walking.
On examination, her temperature is 100.7°F. She has no skin rashes and has 1+ diffuse upper and 2+ lower extremity edema with inability to lift her legs against gravity. She has some tenderness and swelling over a few PIP joints. Laboratory analysis reveals a normal CBC, albumin of 1.7, AST of 35, ALT of 50, with a total bilirubin of 0.6 (normal) and an INR of 1.1. Urinalysis reveals 2+ RBCs and 2+ protein with a 24 hour collection of 1.3 grams (normal <250mg). Hepatitis A/B/C testing is normal. Anti-Cardiolipin antibodies are abnormal and an Anti-mitochondrial antibody and Anti-smooth muscle antibodies were unremarkable. An Anti-nuclear Antibody is 1:80 (normal <1:40). A lower extremity doppler showed a deep vein thrombosis.
Which of the following would be the best test for the diagnosis and determination of management?
This question appears in Med-Challenger Internal Medicine Exam Review with CME
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