A 75-Year-Old Woman Comes to the Physician for Follow-Up After

question 65

Multiple Choice

A 75-year-old woman comes to the physician for follow-up after she was started on prednisone 60 mg daily a week ago for suspected giant cell arteritis.  She had headaches, blurred vision, fatigue, dry cough, and jaw pain with chewing.  She had a normal complete blood count, comprehensive metabolic panel, and chest x-ray, but the erythrocyte sedimentation rate was 88 mm/hr.  A biopsy of the right temporal artery was obtained due to tenderness over that area.
The patient had rapid relief on prednisone with resolution of headaches and significant improvement of her systemic symptoms.  The biopsy report shows no evidence of giant cell arteritis, only atherosclerosis.
Which of the following is the best course of action?

• A)Continue prednisone and add hydroxychloroquine
• B)Discontinue prednisone and advise daily aspirin
• C)Discontinue prednisone and start methotrexate
• D)Obtain biopsy of the left temporal artery
• E)Taper off prednisone slowly over 2 weeks

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