55 yrs old woman presents to her primary care physician with complaints of pain in her hands in the cold. On further questioning she say notices that her hands have a bluish hue when she is outside, and that they become pale and then quite red when warm. Her physician , concerned that raynaud’s phenomenon may indicate the presence of an autoimmune illness, initiates an autoimmune work up that is entirely negative. 3 weeks later the patient returns to the office with reports of visual floaters. She states she feels fine otherwise. Her physical examination is negative aside from several large bruises on her legs. Which of the following is the most appropriate management?
Begin a course of prednisone to alleviate the patient’s autoimmune symptoms in the absence of concrete diagnosis.
Discuss the possibility of domestic violence with the patient.
Order plasma electrophoresis.
Reassure the patient and reevaluate in 3 months.
Resrnd the patient’s serum for antinuclear antibody tests.