26th January 2024

A 55-year-old female presents with pain and swelling of multiple joints in her hands for the past few years.

A 55-year-old female presents with pain and swelling of multiple joints in her hands for the past few years. On examination, she has bony nodules on the distal interphalangeal joints of the left thumb, second and fourth fingers, and on the right second and third distal interphalangeal joints. She is otherwise well, with no systemic features or significant family history. Rheumatoid factor and anti-CCP are negative. She has not sought medical help for this condition in the past. 

Which of the other following features could you not expect to see on examination, given the likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.