methotrexate

A 65-year-old woman presents to her general practitioner with fatigue and pallor. She has a history of rheumatoid arthritis, for which she takes methotrexate and folic acid. She denies any gastrointestinal symptoms or recent changes in her diet. On examination, she appears pale, and her conjunctivae are pale as well. Her blood pressure is 120/75 mmHg, heart rate is 88 bpm, and respiratory rate is 16 breaths per minute. Laboratory investigations reveal hemoglobin of 9.0 g/dL, mean corpuscular volume (MCV) of 105 fL, and normal white blood cell and platelet counts. Which of the following is the most likely cause of her anemia?

A 60-year-old woman presents to the clinic with a 2-month history of progressive shortness of breath and a dry cough. She has a history of rheumatoid arthritis and is currently on methotrexate and low-dose prednisone. On examination, she has fine inspiratory crackles at the lung bases. A high-resolution CT scan of the chest shows reticular opacities and honeycombing predominantly in the lower lobes. What is the most likely diagnosis?

A 62-year-old woman presents to her general practitioner with a 3-month history of progressive shortness of breath, fatigue, and a persistent dry cough. She has a history of rheumatoid arthritis, for which she takes methotrexate and low-dose prednisone. She denies fever, weight loss, or night sweats. On examination, she has clubbing of the fingers and fine inspiratory crackles at the lung bases. Her oxygen saturation is 92% on room air. A chest X-ray shows reticular opacities predominantly in the lower lung zones. Pulmonary function tests reveal a restrictive pattern with reduced diffusion capacity for carbon monoxide (DLCO). Which of the following is the most appropriate next step in the management of this patient?