Case report

A 15 year old boy presented with a three year history of painless swelling of the proximal interphalangeal (PIP) joints of both the hands. The illness started at the age of 12 years without any history of preceding trauma or cold exposure. There was no fever, morning stiffness or pain. There was no limitation of hand functions like writing skills, grasping, etc. However, for the past six months, the patient had noticed flexion deformities of the little fingers, which could not be corrected. No other joints were involved. The patient was one of three children of a non-consanguinous marriage. None of the parents or other siblings had similar illness. The patient had been treated by his doctor for juvenile chronic arthritis with diclofenac sodium and low dose prednisone for six months without any improvement. General physical and systemic examinations were entirely normal. Joint examination showed firm swelling of the PIP joints. No erythema, local rise in temperature or tenderness were noted. The fingers showed flexion deformity. No shortening was apparent. Active and passive movements were normal except in the little fingers, which had a fixed deformity (fig 1 ) …