Q179) A 48 Year old woman is evaluated in your office for a skin eruption that appeared three days ago. Her past medical history is significant for Rheumatoid arthritis for which she uses Methotrexate. She recently had increasing joint pain and she was placed on ibuprofen which takes about three times daily. Her joint pain is well controlled now. She is now concerned about the skin eruption that is predominantly distributed on her arms, hands and feet. The eruption is painless. On examination, there is no joint swelling or tenderness, range of motion in the joints is normal. Skin examination reveals the lesions as shown in the image below.
The most appropriate management option for this patient:
B) Stop Ibuprofen
C) Start Acyclovir
D) Intra-lesional corticosteroids
E) Anti-citrullinated pep-tide levels