Joycelyn. is a 49-year old married mother of 2 active boys and 1 daughter, ages 12, 15, and 18. She enjoys
attending their sporting events. She also loves her part-time job as a musician.
Seven months ago, Joy began noticing stiffness in both hands in the morning that lasted longer and longer.
Stiffness now lasted more than 1 hour every morning and included hands, wrists and ankles. She also had
increasing difficulty standing for long periods at work or at home due to foot and ankle pain. She began taking
ibuprofen 800mg 3 times daily and found it helped her get through her day with less pain and stiffness.
Three months ago, Joy noticed pain in her right and left shoulders when she would cut or blow dry her client's
hair. She also began feeling extremely tired and short tempered. She had no energy to do her usual activities.
Ibuprofen was no longer very effective for her pain or stiffness.
One morning, Joy could not lift her arms at all without extreme shoulder pain. She knew it was time to get
help. She had been speaking with her friends and they encouraged her to see a doctor. She saw her Primary
Care Physician (PCP), who examined her and ran a few preliminary blood tests.
Questions:
Joys PCP referred her to what specialist ?
Based upon the above clinical information, what do you believe her diagnosis is?