Discover a case of widespread joint pain and digital clubbing in a smoker. What’s the critical next step when radiographs show symmetric Periostitis?
A 55-year-old woman with a 29-pack-year history of smoking presented with a 1.5-year history of pain in her fingers, wrists, hips, knees, and ankles. On physical examination, clubbing and slight thickening of the skin of the fingers and toes were noted (left image, right foot). There was mild tenderness on palpation of all her affected joints but no erythema or swelling. A cardiopulmonary examination was normal. Radiographs of the forearms, hands, femurs, tibia, and feet showed symmetric periostitis of the tubular bones (right image, right ulna and radius, arrows). Which of the following is the most appropriate next test in her evaluation?
