A 64 -year-old man presented with a 2-month history of swelling in his knees, ankles, hands, and feet. He had an 8-lb weight loss over a few months. He denied experiencing any fevers, chills, night sweats, or morning stiffness. He admitted to fatigue, but denied experiencing myalgias, weakness, vision changes, or oral lesions. He also denied respiratory symptoms. His medical history included eczematoid dermatitis for which he was prescribed prednisone, 10 mg daily, and phototherapy. He was a lifetime nonsmoker, worked as a brake mechanic, and had done no recent traveling.