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A 16-year-old boy comes to the health care provider complaining of a persistent sunburn on his face that started when he was on vacation 2 weeks earlier and does not seem to be improving. He also complains of headache, chills, fever, and joint pains that are most prominent in the hands with the pain being the worst in the morning. Aspirin seems to improve the symptoms somewhat. He has no significant past medical history and does not take any medication on a regular basis. He denies allergies to medications. On physical examination, the patient is a well-developed and well-nourished young man. His temperature is 37.3°C (99.1°F), blood pressure is 140/90 mm Hg, pulse is 80/min, and respirations are 16/min. Inspection of the skin reveals diffuse erythema and edema of the nose and cheeks in a butterfly distribution and erythema and edema of the skin overlying the interphalangeal part of his fingers. The proximal and distal interphalangeal joints of the fingers are edematous and tender and his fingertips are studded with minute violaceous papules tender to touch. On the hard palate, there are several shallow ulcers up to 1 cm in diameter. Laboratory studies show:
RBCs 2.8 x 1012/L (normal 4.7-6.1 million cells)
WBCs 2.2 x 109/L (normal 5,000-10,000)
Platelets 200 x 109/L (normal 150,000-400,000)
Erythrocyte sedimentation rate 57 mm/h (normal <20 mm/h)
Urine protein 4+ (normal negative)
Which of the following is the most appropriate screening lab test for this patient?
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