History and physical examination
A 44-year-old female known Rheumatoid arthritis patient on treatment
for the past 10 years initially presented with a complaint of multiple
Joint pain and lower back pain of 4 months duration. Associated with
that she also had a history of morning stiffness of the involved joints
which usually stayed for 2 to 3 hours. Up on Physical examination, the
initial presentation revealed a tender wrist, left knee,
metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints of
her hands but no limitation of movement. photo(figure 1) showed
subluxation of the bilateral interphalangeal joint of the thumb.