A 48-year-old female presented with pain and swelling in the bilateral proximal interphalangeal (PIP), metacarpophalangeal (MCP) and wrist joints for the past 20 days. It was acute in onset, severe in intensity to such an extent that she was unable to make a fist. It was associated with acute onset of diffuse painful swelling over the dorsum of hands. History of morning stiffness was present, lasting up to 1 hour, and eases only slightly with the consumption of painkillers prescribed by a local general practitioner.
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