Mrs. Cindy Edsworth is a 30 year old African Canadian lady who describes the onset of joint pains which have been on going for 3 months. She describes that the small joints of her hands are constantly aching and over the past 4 weeks she describes having swelling in the PIP and DIP joints of both hands. Over the past week she points out that she is having significant swelling affecting the feet that reaches the ankles. With the onset of the joint pains she developed alopecia and a scarring type rash over the scalp. She has been quite fatigued. She finds she is exhausted when she awakens in the morning and by 6:00 pm she has to go to bed because of persistent fatigue. Cindy also finds that she has become quite irritable. Her temper is easily disturbed and she is also becoming quite argumentative with her husband. Her husband is disturbed by her recent change in mood.