Chronic swelling of the PIP joints and wrist

Abstract

A 48-year-old man presented with a three-year history of painful swelling of the finger joints and left wrist. Examination revealed tenderness and swelling of the right second and left third proximal interphalangeal joints. Rheumatoid factor was positive, and C-reactive protein was elevated (25 mg/L). Radiographs demonstrated marginal erosions, particularly at the right second metacarpophalangeal joint, with additional suspected erosions in the left carpus despite overlapping bones. Some rounded cystoid lesions may represent erosions not fully visible on radiographs. The asymmetric distribution highlights an important presentation of rheumatoid arthritis and the value of carefully assessing subtle erosive changes in both hands.