Ms. Smith is a 38 year-old African-American female who presents to your office with a three month history of joint pain. The patient first noticed pain in her ankles when she was walking with friends in the morning. The pain resolved with rest. Several weeks later, her knees began to hurt as well. Her left knee may have become swollen when the pain was especially severe. During the past few weeks she has noticed stiffness and aching in her hands that is more pronounced in the morning. The stiffness and pain improved with an over the counter NSAID. Her rings seem to fit tightly - she has been unable to get her wedding ring off for the past three weeks but she does not think her hands are swollen. She has noticed that her dandruff has increased and it has not improved after changing to Head and Shoulders shampoo. Also, she has episodes of chest pain that is worse with deep inspiration.