This book is for postgraduate fellows, internists, and students interested in rheu- tology. It contains real cases and is designed to stimulate thought and further reading in this rapidly evolving specialty. I have included a series of common and uncommon cases that I have seen over the past decade in a busy consultative practice and have inserted up-to-date ref- ences and questions you may be asked on ward rounds or in clinic. My hope is that it will be a useful adjunct for physicians preparing for examinations or entering the field and will stimulate further interest. I would like to ackwledge my mentors Pierre Bouloux, MD, Tom Cooney, MD and thank Atul Deodhar, MD for his careful review of the manuscript. This book is dedicated to my parents and wife Batool who have made many sacrifices for which I remain eternally grateful. Brooklyn, NY Yousaf Ali v Contents Preface ...v Self Assessment Questions ...1 Index ...141 vii Question 1 A 56-year-old female presents with arthralgias and fatigue. Lab work is unrema- able apart from rmocytic anemia and Howell Jolly bodies on peripheral smear. Her examination reveals a blistering rash on the elbows.