50-year-old female complaining of painful joints in both hands. The radiographic features suggest erosive osteoarthritis. As it is an emergency condition the referring physician was informed.

Radiological features can differentiate between erosive arthritis and other arthritis:

• central erosion (gull wing appearance)
• usually seen in the distal interphalangeal joints   
• spares metacarpophalangeal joints

Special thanks to Dr Tamer Elholiby.