• 43-year-old lawyer
  
• Commutes to work—one hour each way
  
• Seropositive rheumatoid arthritis (RA) for 12 years.On initial diagnosis she was told her RA test was very "high."
• Takes ibuprofen and glucosamine.
  

Further questioning reveals that Mrs. B.:

• Complains of pain "all over" with her feet and hands being the worst
  
• Has no energy
  
• Has a poor appetite
  
• Has "dizzy spells," feels light-headed and unsteady but there is no vertigo
  

Further systems review is unrevealing.

Her current medications are:

• ketoprofen 100 mg supp. pr od
  
• ranitidine 150 mg bid
• Glucosamine
  

next: exam