severe joint pain - mostly in shoulders and wrists, but also some in hips and knees; numbness and burning sensations in first 3 fingers in both hands - more on left hand; weak hand grips bilaterally, mild swelling on the left wrist without redness or pitting; general stiffness in all major joints - not changed with exercise. some relief with ibuprofen/ice; no fever, no vomiting or diarrhea, denies heart pain or palpitations, denies SOB or cough, 1 headache in the last week, no rash, no difficulty urinating, no recent injury; 55 yo male, previous left shoulder injury and whiplash injury 10 yrs ago.