A 49 yo woman with past medical history history of rheumatoid arthritis presents to the emergency room with a 2 day history of a severely painful, warm, swollen Right knee. The patient has been on treatment with prednisone and methotrexate . Her symptoms were well controlled until recently. She denies any pain or swelling in any other joints at this time. Physical examination reveals swollen and tender right knee. She is afebrile. The most appropriate next step in management is:
A. Add infliximab
B. Increase dose of Methotrexate
C. Obtain x-ray of the Knee
D. Arthrocentesis
E. Intra-articular glucocorticoid injection
d
d
d
dd
d
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D
ddd
D