A 43-year-old woman comes to the physician because of a 3-week history of progressive weakness. She has had increased difficulty combing her hair and climbing stairs. She has hypertension. She has smoked one pack of cigarettes daily for 25 years. She does not drink alcohol. Her mother had coronary artery disease and systemic lupus erythematosus. Her current medications include chlorthalidone and vitamin supplements. Her temperature is 37.8°C (100.0°F), pulse is 71/min, and blood pressure is 132/84 mm Hg. Cardiopulmonary examination shows no abnormalities. Skin examination findings are shown in the exhibit. Which of the following is the most appropriate initial treatment for this patient's current condition?

Question

A 43-year-old woman comes to the physician because of a 3-week history of progressive weakness. She has had increased difficulty combing her hair and climbing stairs. She has hypertension. She has smoked one pack of cigarettes daily for 25 years. She does not drink alcohol. Her mother had coronary artery disease and systemic lupus erythematosus. Her current medications include chlorthalidone and vitamin supplements. Her temperature is 37.8°C (100.0°F), pulse is 71/min, and blood pressure is 132/84 mm Hg. Cardiopulmonary examination shows no abnormalities. Skin examination findings are shown in the exhibit.  Which of the following is the most appropriate initial treatment for this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: Dermatomyositis is characterized by proximal muscle weakness (similar to polymyositis) and dermal manifestations (eg, heliotrope rash, Gottron papules).  Laboratory testing shows elevated muscle enzymes (eg, creatine kinase) and autoantibodies (eg, antinuclear, anti-Jo-1).  Initial treatment includes systemic glucocorticoids and evaluation for potential underlying malignancy.

A 43-Year-Old Woman Comes to the Physician Because of a 3-Week