Figure 1: Conventional radiograph postero-anterior view of both hands showing joint space narrowing of all the DIP joints bilaterally and subluxation of the third left DIP, fourth left PIP joints and second, third right DIP joints, third, fourth PIP joints. Remarkably, MCP joints and wrists are spared. Note “gull-wing” appearances (thick arrows) in the distal plate of third left and second, third fourth left DIP joints; “saw-tooth” (thin arrow) appearance in the second right DIP joint. Marginal osteophytes are also noted. Carpal joint space narrowing is also shown. Mild overlying soft tissue swelling is also demonstrated over the PIP and DIP joints