A handful of inflammation.

Rheumatoid arthritis is an autoimmune disease typically affecting the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints as well as larger joints like the wrists, shoulders or knees. We present a case of a 49-year-old woman with symmetrical pain not only in her knees, shoulders, wrists, and MCP and PIP joints but also in her distal interphalangeal (DIP) joints. She has elevated levels of rheumatoid factor and anticitrullinated protein antibodies and a highly active arthritis on magnetic resonance imaging of her right hand in the wrist, MCP, PIP, and 3 out of 4 DIP joints. In summary, we diagnosed a seropositive rheumatoid arthritis affecting all but 1 joint of her hand. This case highlights the very rare (less than 0.2%) affection of 3 out of 4 DIP joints in rheumatoid arthritis.