A 47 year old woman comes to the physician because of poor sleep, general weakness, fatigue, mood disturbances, headache, musculoskeletal pain, and joint tenderness for the last seven months. Her recent lab report of CBC, ESR, basic metabolic panel, TFTs, muscle enzymes, urinalysis, ECG, chest xray were within normal limits. Physical exam was significant for multiple areas of joint tenderness. What is the most appropriate initial management in this patient?
A. Cognitive behavioral therapy
B. Prednisone
C. Fluoxetine
D. Amitriptyline
Answer:D
A 47 year old woman comes to the physician because of poor sleep, general weakness, fatigue, mood disturbances, headache, musculoskeletal pain, and joint tenderness for the last seven months. Her recent lab report of CBC, ESR, basic metabolic panel, TFTs, muscle enzymes, urinalysis, ECG, chest xray were within normal limits. Physical exam was significant for multiple areas of joint tenderness. What is the most appropriate initial management in this patient?
A. Cognitive behavioral therapy B. Prednisone C. Fluoxetine D. Amitriptyline