Painless nodules in the fingers.

Volume 83, Number 10 www.aafp.org/afp American Family Physician 1203 A 61-year-old woman presented with a history of chronic pain and stiffness in multiple joints. She had morning stiffness in her hands, hips, and knees that gradually improved with activity. She did not report any foot pain or stiffness, fever, or rash. On examination she had swelling around the distal interphalangeal joints in multiple fingers with relative sparing of the proximal and metacarpophalangeal joints (Figure 1). The joints were not warm or tender to palpation. Laboratory studies showed normal values of rheumatoid factor and anticyclic citrullinated peptide, and a normal white blood cell count. Hand radiography was ordered (Figure 2).