A 32 year
old female presents with a history of pain and swelling of her joints. She has
not had any serious illness in the past and is not on any medications .
examination you note that she has swelling,
distal interphalangeal joints of the index and middle fingers of her right
hand and swelling of the distal interphalangeal joints of the 4th
and 5th fingers of her left hand .
Investigations reveal elevated inflammatory markers.
a careful examination to look for:
Nodules over her elbows
Pitting of her nails