A 50-year-old female presented with complaints of pain and stiffness in both her hands for the last one year. She had stiffness and restricted joint movement of hands throughout the day, with an associated t ightening of the skin, and denied signs of dry eyes and mouth, or any change in the skin color of her fingers during the cold weather. She had a history of type 2 diabetes for the past ten years. However, she did not follow-up on her diabetes for about a year.
Physical examination Thick, tight, waxy skin of hands with limited joint movements (Cover image A). Incomplete approximation of digits when the palmar surfaces of the proximal and distal interphalangeal joints were pressed together with abducted fingers – positive "prayer" sign (Cover image B). Inability to lay her palms flat on a horizontal surface – positive "tabletop" sign Presence of early Heberden's nodes in her distal…
