A 26-year-old woman is evaluated for joint pain affecting the elbows, knees, and ankles for the past month. For the past 4 weeks, the patient has had fatigue and malaise. She has also had a 4-kg (9-lb) weight loss during this time period despite having normal appetite. She also has a 1-year history of dry, nonproductive cough and mild exertional dyspnea. There is mild swelling and tenderness of the elbows, knees, and ankles. The lower extremities are tender to palpation and have scattered erythematous nodules. Chest x-ray reveals lung nodules and hilar fullness. Transbronchial biopsy shows large epithelioid cells, occasional giant cells, and no areas of necrosis. Which of the following pharmacotherapies is most appropriate for the initial treatment of this patient?

Question

A 26-year-old woman is evaluated for joint pain affecting the elbows, knees, and ankles for the past month. For the past 4 weeks, the patient has had fatigue and malaise. She has also had a 4-kg (9-lb) weight loss during this time period despite having normal appetite. She also has a 1-year history of dry, nonproductive cough and mild exertional dyspnea. There is mild swelling and tenderness of the elbows, knees, and ankles.  The lower extremities are tender to palpation and have scattered erythematous nodules.  Chest x-ray reveals lung nodules and hilar fullness.  Transbronchial biopsy shows large epithelioid cells, occasional giant cells, and no areas of necrosis.  Which of the following pharmacotherapies is most appropriate for the initial treatment of this patient?

Quizplus · Accepted Answer

Eductional Objective: Sarcoidosis commonly presents with hilar adenopathy, pulmonary infiltrates, and skin findings (eg, erythema nodosum).  Biopsy shows noncaseating granulomas composed of epithelioid cells (activated macrophages) and giant multinucleated cells.  Oral glucocorticoids are the initial treatment of choice.

A 26-Year-Old Woman Is Evaluated for Joint Pain Affecting the Elbows