,HISTORY OF PRESENT ILLNESS: , The patient is a 56-year-old female with a history of systemic lupus erythematosus, who was last seen in rheumatology clinic approximately 4 months ago for bilateral hand discomfort, left greater than right. 
,HISTORY OF PRESENT ILLNESS : , The patient is a 56 - year - old female with a history of systemic lupus erythematosus , who was last seen in rheumatology clinic approximately 4 months ago for bilateral hand discomfort , left greater than right .