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Involving patients in decision making may help improve the quality of care.

Increasing physical activity has proved effective in improving patients’ overall health and preventing and managing chronic diseases and complications, such as obesity, coronary artery disease, diabetes mellitus, arthritis, and osteoporosis.

Young-Min S, Cawston T, Marshall N, et al, Queen Alexandra Hospital, Portsmouth, UK, and other centers. Biomarkers predict radiographic progression in early rheumatoid arthritis and perform well compared with traditional markers. Arthritis Rheum. 2007;56:3236-3247.

He had bilateral hand pain. History included rheumatic fever, aortic valve replacement, corticosteroid-induced osteonecrosis, and total left hip arthroplasty.

She caught herself with her hands in a forward fall. A year later, her wrist is still painful. What should be done?

A 79-year-old white woman presented with ulcerative colitis of 12 years’ duration and osteoporosis. She was referred to rheumatology for severe proximal muscle pain that was unresponsive to NSAID therapy.

A 29-year-old African American woman came to our rheumatology clinic with right hip pain that had been getting worse for the past 3 months. She had been diagnosed with systemic lupus erythematosus (SLE) 2 years earlier. She reported excruciating right hip pain and mild pain in her left hip on weight bearing and, occasionally, at rest.

A 48-year-old woman presented to the orthopedic clinic with dull, persisted pain in the sacroiliac area that was impervious to NSAIDs. She denied knowledge of any injury or other possible explanation.

An 18-year-old complained of pain and decreased mobility of the small finger in his right hand after a softballinjury. While sliding back to second base during a pickoff attempt, the patient hit his hand on the bag.

A 55-year-old American Indian truck driver presentedwith a 2-day history of right wrist swelling and pain. He denied previous trauma to the wrist or having performed unusual activities.

A 63-year-old woman presented with a 2-year history of bilateral hand pain and stiffness that had worsened in recent months. The pain was most severe in the fingers and was associated with morning stiffness that lasted 30 minutes. There was loss of full range of motion in some finger joints.

A 51-year-old African American man with a 15-year history of chronic hepatitis C and sarcoidosis presented with persistent bilateral hand pain. The pain was aggravated by physical activity and had a waxing-and-waning pattern.

A 56-year-old man presented with a 1-week history of digital tip ulcers and ischemic gangrene. He alsoreported the recent onset of Raynaud phenomenon and diffuse joint pain.