When Going for the Gold Is Not an Option

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Abstract
A 25-year-old, previously healthy white man consulted his physician because of a two-month history of progressive diffuse joint pain. Initially, the patient noticed pain in his left elbow on awakening. The pain soon involved both knees and ankles and persisted for longer periods during the day; it then became constant and was accompanied by fatigue. One month after the onset of joint pain, low back stiffness developed, which was worse on awakening, improved with activity, and increased again at the end of the day. The physical examination was unremarkable. The erythrocyte sedimentation rate was 20 mm per hour, the . . .

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