Pencil-in-cup deformity - rheumatoid arthritis
Bilateral hand pain
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Symmetrical polyarthropathy involving both the carpus and fingers. Marginal erosions are most apparent in the carpus. On the right lateral projection, there is a pencil-in-cup deformity of the fifth finger. No soft tissue calcification.
This patient had a long-standing history of rheumatoid arthritis. Pencil-in-cup deformity is classically associated with psoriatic arthritis but can also be associated with rheumatoid arthritis as well as systemic sclerosis (scleroderma) and reactive arthritis.