Young woman in her thirties presents with a case of body ach | Figure 1

Young woman in her thirties presents with a case of body aches (primarily in her legs, knees, and back), headache, cough, fatigue, and this rash which presented on bilateral knees, bilateral elbows, bilateral tops of feet and is itchy. She had a low grade temp of 99.9 but says she had the flu. She did vomit once earlier in the day but wasn’t sure if it was related to this or her vitamin that she takes. Vitals stable at office but she does appear to be fatigued and pale. Recommendations on any labs I should run? I was thinking maybe Ana due to the placement of the rash along with joint pain complaint. She has no medical hx and no hx of allergies or asthma.

Update 1

ANA was negative but SSA is positive along with positive Anticardiolipin Antibodies. She recently suffered a miscarriage as well. Oddly enough, I had another patient with the same presentation and both are now being sent to rheumatology.