Presentation
Patient with inflammatory markers elevated positive for arthritis. The previous x-ray showed PIP chronic deformity. Evaluation before starting methotrexate.
Patient Data



The radiographs of the hands demonstrate the presence of marked erosive changes at the PIP joint of the left index finger.
The erosive changes are characterised by subchondral central erosion at the heads of the proximal phalanx with marginal osteophytes involving the middle phalangeal base (gull-wing appearance), diffuse cartilage loss and joint space narrowing.

Gull-wing appearance (phalanges).
Thank you to Bruno for the image.
Case Discussion
Findings are in keeping with erosive osteoarthritis.