A 26-yeаr-оld wоmаn in her first trimester оf pregnаncy is evaluated in the emergency department for an acutely painful left wrist and painful, swollen right knee. Four days ago, she developed flu-like symptoms characterized by migratory joint pains. Her pregnancy had been uncomplicated. On physical examination, the right knee has a warm effusion and the left wrist is slightly warm but not swollen. Passive wrist motion is uncomfortable and resisted extension is extremely painful. The joint capsule of the knee is tender. On pelvic examination, there is a scant mucoid cervical discharge. The remainder of the general examination is normal. Arthrocentesis of the knee yields 20 mL of fluid (leukocyte count, 14,000/μL; 90% neutrophils). Gram stain is negative. Which of the following is the MOST APPROPRIATE NEXT STEP in this patient's management?
A 45-yeаr-оld mаn is evаluated in the оffice fоr a 3-month history of gradually worsening fatigue and weakness. He notes progressive difficulty getting in and out of his bathtub and his automobile. He does not have cough or shortness of breath, difficulty swallowing, nasal regurgitation and aspiration, hoarseness, or change in voice. His weight has been stable. He has no other medical problems and takes no medications. On physical examination, vital signs are normal. He has difficulty rising from a chair without using his arms for assistance, and he has weakness of his shoulder muscles. There is no pain with palpation of the muscles and no restriction of joint movement. Laboratory evaluation shows a normal complete blood count, serum creatine kinase of 5600 U/L, and erythrocyte sedimentation rate of 32 mm/h. Which of following is the MOST LIKELY DIAGNOSIS?