A 59 year old woman with an eight year history of seropositive erosive rheumatoid arthritis (RA) receiving sulfasalazine and penicillamine presented with severe sudden onset pain radiating from the left elbow to the left thumb, index and middle fingers. Examination disclosed synovitis of the left wrist, which might have caused median nerve compression. The wrist joint was injected with 20 mg of triamcinolone acetate with 1% lidocaine (lignocaine). She returned the …