A middle-aged black woman has been experiencing swelling of her arms and legs for the past 5 years. The swelling appears every 3 to 5 months. She has been evaluated by several physicians, including a rheumatologist, but no one can provide a definitive diagnosis. Lupus cell test is always negative, as are scleroderma and rheumatoid tests. When the swelling appears, she complains of stabbing pain in that extremity. Any suggestions as to potential referral or additional diagnostic testing?


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