A 49-year-old female developed polyarthritis for 2 weeks following a non-specific rash around the right ankle a week prior to the onset of her joint symptoms. The joint pain was associated with night sweats, malaise and fatigue and weight loss of 5 kg in 3 weeks. The rash resolved spontaneously over 2 weeks and reappear over left ankle. She denied a preceding infection and had no symptoms of a sore throat, gastrointestinal or genitourinary infection.
There was no medical history of joint pain, oral ulcer, photo-sensitivity, uveitis, psoriasis or inflammatory back pain. Family history was not significant. A presumptive diagnosis of acute arthritis was made by her general practitioner, and she was prescribed 1 weeks of twice-daily oral analgesic and subsequently 1 week of oral steroid. There was no improvement in joint and constitutional symptoms after completion of 2 weeks of oral…
