A 37-year-old man who had a 4-day history of symmetrical severe arthralgia of the hands,
wrists, elbows, shoulders, ankles, and knees consulted an orthopedist. The orthopedist
prescribed a nonsteroidal antiinflammatory agent, but the arthralgia did not improve. The
next day, the patient was referred to my department. He reported experiencing no rash or
other systemic symptoms except for a 2-day history of fever 17 days earlier. His medical
history was unremarkable. On physical examination, his vital signs were normal. He had no …