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.