A 46 year old black woman, born in Haiti, was admitted in 1999 owing to bilateral and symmetric arthritis of the hands. Her past history was unremarkable. She had lived in New York in the 1970s, where she sustained an episode of severe frostbite in 1977 while staying outside for 1 hour at a temperature of −20°C without protection. Frostbite affected all fingers but not the thumbs, requiring admission to hospital for 11 days (amputation of some fingers was discussed at this time).

She had complained about arthritis affecting the interphalangeal (IP) joints since 1994, without extra-articular involvement or fever. Progressive joint deformations appeared at this time. Clinical examination was normal except for proximal IP joint deformation.

Routine laboratory tests, immunological tests (antinuclear antibodies, rheumatoid …