Review Question - QID 214772

A 34-year-old woman presents to the clinic with complaints of joint pain for the past several weeks. The pain initially began at the right knee but has now “spread” to her left ankle, right elbow, and right wrist. The pain is rated as a 5/10 and does not limit her day-to-day activity. She denies any stiffness, fever, lightheadedness, dysuria, chest pain, shortness of breath, or chills. She has no significant past medical history and takes no medications. Her temperature is 98.6°F (37.0°C), blood pressure is 115/70 mmHg, pulse is 70/min, and respirations are 12/min. A physical examination demonstrates mild joint effusion and tenderness at the right wrist and elbow with full range of motion. A skin rash on her back is shown in Figure A. In addition, there is a holosystolic murmur heard best at the apex. Which of the following is most associated with this patient’s presentation?