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A 58-year-old man presents with a 4-month history of facial erythema. He complains of progressive pain and weakness in his shoulder and lumbar girdle, and he has difficulty swallowing food. His medical history is remarkable for diabetes mellitus and hypertension over the past 20 years. When explored, his symptoms reveal malar erythema and telangiectasia with infraorbital edema. Both hands show red papules, mostly over the bony prominences.