A 33-YEAR-OLD black man was admitted to The Johns Hopkins Hospital with polyarthritis, rash, and weight loss. The patient had been well until approximately 2.5 years before hospital admission, when he noted the onset of an acneiform rash over his scalp and face and abscesses in his groin and axillae. One year later, he developed pain in both of his hips. The pain soon spread to his knees, ankles, feet, shoulders, and wrists. The affected joints were swollen and tender. His temperature remained normal. Short courses of aspirin and indomethacin failed to bring the patient complete relief. The onset of severe back pain, combined with hours of morning stiffness, caused him increasing difficulty with walking. He had to give up his job as a meat cutter.
He presented to the Rheumatology Clinic at Johns Hopkins because of increasing disability from his joint and skin disease, along with a 13.5-kg loss