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Raynaud's Phenomenon, Inflammatory Arthritis, and Weight Loss: Pay Attention to the Man Behind the Curtain

In the winter of 2012, a 52-year-old African American woman noted changes in the color of her fingers upon exposure to cold, characteristic of Raynaud’s phenomenon. Her digital cold sensitivity worsened over the ensuing months. She then developed stiffness and pain in her hands and wrists that interfered with routine daily activities, including opening jars or making a fist. In March 2012, she noticed swelling in both knees that led to difficulties in getting out of bed, up from a toilet seat, and in and out of a bathtub. She used naproxen, acetaminophen, and topical salicylate (15% methylsalicylate and 10% menthol), each without symptomatic improvement. In April, red blotches appeared on her hands accompanied by hypopigmented patches on her cheeks and forehead. By the end of the month, she developed new and severe heartburn and chest pain, alleviated by high-dose protonpump inhibitor therapy. In May, her primary care physician prescribed a 1-week course of prednisone 20 mg daily as treatment for a presumed rheumatoid arthritis (RA) flare, and on the third day, she noted substantial symptomatic and functional improvement. On day 8, the prednisone dose was decreased to 10 mg daily and she continued at this dose until she was evaluated in rheumatology consultation. Medical history