A 45-Year-Old Woman Comes to the Office Due to Progressive

A 45-year-old woman comes to the office due to progressive stiffness, pain, and swelling of the joints in the hands and wrists for the past 3 months.  The symptoms are worse when she wakes up and gradually improve after several hours.  The patient also feels fatigued but has had no skin rashes, oral lesions, or fever.  She recently began taking chlorthalidone for hypertension and takes no other medications.  She works in a daycare center.  The patient drinks alcohol occasionally and does not use tobacco or illicit drugs.  Her mother had "arthritis" in her older age, and her sister has systemic lupus erythematosus.  Temperature and other vital signs are within normal limits.  Physical examination shows warmth, swelling, and tenderness of the second and third proximal interphalangeal joints, the metacarpophalangeal joints, and the wrists of both hands.  The remainder of the examination shows no abnormalities. Additional laboratory results show normal hepatic aminotransferase levels.  The patient is advised to avoid alcohol consumption.  She receives appropriate immunizations, and methotrexate therapy is begun.  Which of the following additional interventions is the most appropriate in this patient?

A) Folic acid supplementation
B) Periodic creatine phosphokinase level testing
C) Periodic pulmonary function testing
D) Prophylactic trimethoprim-sulfamethoxazole
E) Pyridoxine supplementation