A 30-year-old woman sought care at an Indian rheumatology clinic, experiencing discomfort, swelling, and morning stiffness in the joints of both hands for two years. Her complaints involved the wrist, metacarpophalangeal, and interphalangeal joints.
For six months prior to seeking treatment, the patient had been taking methotrexate due to suspicion of rheumatoid arthritis, but her symptoms showed no improvement. During the examination, doctors noted several signs: a swan-neck-like deformity, slight ulnar deviation of fingers from the second to the fifth, and a characteristic Z-shaped deformity of the first fingers of both hands upon extension. It should be noted that these deformities almost disappeared when the hands were clenched into fists or pressed against a table.
This clinical case was described by doctors Ranjan Gupta and Rudra Prasad Goswami in The New England Journal of Medicine.