]> 2026-07-31T07:51:38+00:00 WBR0409 0 en Influenza vaccination Sputum microscopy Hepatitis B vaccination Hepatitis C vaccination '''Incorrect''' : No prophylactic or therapeutic vaccine for hepatitis C exists. PPD Primary Care Office 40 year old nurse presents to the office with one year H/O joint pains and stiffness. She says her symptoms are gradually progressing and not responding to over the counter NSAID’s. She experiences pain usually early morning that improves during the day. Since the start of this august she feels her symptoms are prolonged and her physical activities are restricted due to her symptoms. Her past medical history and family history are insignificant. She is a chronic smoker and alcoholic. Physical examination shows mild hyperemia and swelling of the proximal small hand joints, wrists and knees with restriction of movements. Examination of the other joints are normal. Initial knee X-ray shows periarticular joint erosions. RF and ESR are markedly elevated. What is most appropriate next step before starting her on her first DMARD? C Musculoskeletal/Rheumatology 2020-10-28T00:28:30Z 2459150.5197917 WBR0409