A 62 years-old woman complaining of pain at first metacarpophalangeal joint for 15 days, no relief with chymotrypsinogen enzyme tab for five days, no history of injuries or fall noted by the patient. She is diabetic and hypothyroid, on levo thyrox 75 mcg and injection dulaglutide 1.5 mg weekly for two years with metformin two grams and a lot of calcium and vitamins. Undergone Hysterectomy 15 years ago.

Sedentary life from two years. Is this fracture of MCP joint or side effects of dulaglutide?