Excerpt
We evaluated a 67-year-old woman for bilateral hand swelling and pain for 3 months. During this time she developed small erythematous papules on her wrists, fingers, and ears. On examination she had superficial nodulosis on the pinnae of her ears, elbows, and fingers, and along her cuticles, which had a “beaded string” appearance (Figure 1). She had synovitis involving her metacarpophalangeal joints and wrists bilaterally. Her laboratory values were remarkable for elevated rheumatoid factor and a normocytic anemia. Anticyclic citrullinated peptide antibodies were also present. Hand radiographs showed no erosive changes. She underwent biopsy of a finger nodule that revealed...
