Stage A 38-year-old man came to the outpatient clinic complaining of symmetrical swelling and pain in his hands. Two months earlier he had been in Moscow as a tourist. One month later he contracted a flu-like illness, followed by generalized malaise, fatigue, diffuse myalgia, arthralgia, and morning stiffness. These symptoms improved somewhat during treatment with oral diclofenac. Response At this point it seems that the patient has arthritis, which could be related to a previous infection. Arthritis may accompany illnesses caused by a number of viruses, including rubella, parvoviruses, enteroviruses, and adenoviruses. Usually rheumatic symptoms first become apparent as a.