A 50-year-old patient with long-standing chronic obstructive lung disease develops the insidious onset of aching in the distal extremities, paicularly the wrists bilaterally. There is a 9kg weight loss. The skin over the wrist is warm and erythematous. There is bilateral clubbing. Plain film is read as periosteal thickening, possible osteomyelitis. You should
Sta ciprofloxacin Obtain chest x-ray Aspirate both wrists Begin gold therapy