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To the Editor:
A 31-year-old woman was referred to our rheumatology department in February 2002 for tender ulnar styloids and decreased range of motion in her wrists. During the previous 3 years she had intermittent swelling of her second right proximal interphalangeal joint (PIP) and metacarpophalangeal (MCP) joints, with early morning stiffness treated with nonsteroidal anti-inflammatory drugs. Radiographs of hands and wrists were normal. Her rheumatoid factor (RF) was positive at 70 IU/ml (normal 0–14 IU/ml), erythrocyte sedimentation rate was 10 mm/h, antinuclear antibodies and extractable nuclear antigen were negative and serum complement levels were normal. The patient received…