31st January 2024

A 35-year-old female from Romania is seen on the medical take with neck stiffness and meningitis.

A 35-year-old female from Romania is seen on the medical take with neck stiffness and meningitis. She reports feeling generally fatigued with pain and stiffness over both arms, legs and around her neck. She is also complaining of some trouble swallowing and bloating but no photophobia or headache. These symptoms have been going on for 4 months. She has no past medical history, although a friend mentioned she might have fibromyalgia. Her observations are normal. On examination she is tender over her upper arms, neck and thighs, with weakness on shoulder abduction. There is no evidence of meningism. FBC, U&E, and CRP are unremarkable. 

Which of the following is the most important next step?

Select the SINGLE most appropriate option from the list below. Select ONE option only.