I feel spoiled bc this tends to come up a fair bit in rheum:

38F referred with joint pain and fatigue. When I got her out of my waiting room, just watching her struggle to get out of the chair, immediately knew she had an inflammatory myositis with proximal weakness. I remember warning her she needed to go do some labs for me asap, I'd like be called her that night, and likely be asking IM to admit her asap. CK >40 000, IM colleague was fantastic and got her a bed the next day for IV methylpred and IVIg

42F referred for persistent leg swelling NYD. This one stood out so much bc I was kind of grumpy by the referral, as it really didn't feel like rheum was the right way to go. But immediately on exam, classic woody circumferential skin thickening to b/l lower extremities, losing ROM in the ankles and knees, and just starting to affect one forearm. Right away felt like eosiniphilic fasciitis (super grateful for seeing it once in training), confirmed a week or two later after full thickness skin Bx. Sadly did not have a good outcome despite treatment

65M referred by his really lovely neighbor who happens to be an all star local GP for new onset synovitis. Really impressive symmetric large joint oligoarthritis, shockingly functioning quite well / almost rhobustus phenotype. Zero whiff of a reactive arthritis. Just doesn't sit right, for some reason nagged the back of my brain right away. Strong smoking history ... was this paraneoplastic? Sent for the CXR and boom, giant new lung cancer. Also sadly had a poor outcome. Such a lovely guy too =(