A 57-year-old female presents with a history of painful
joints of several months duration. The pain mainly affects the small joints of
both hands, they are swollen and stiff and the stiffness is worse in the
mornings. She also complains of feeling generally unwell, fatigued, feverish
and has lost weight.
On examination you note that there is symmetrical
swelling of her wrists, the metacarpophalangeal joints and the proximal
interphalangeal joints. There are nodules at both elbows.
In this patient which one of the following x-ray changes
may be seen on x-rays of her hands?