Rheumatoid nodules

Marked by the arrowheads there are 2 rhematoid nodules in the region of the wrist of this pleasant lady. The presence of rheumatoid nodules signifies 2 things in a patient with RA:

1. High likelihood of being Rheumatoid factor positive &

2. More severe disease

She also suffered from other deformities of her hand

There is ulnar deviation seen at the wrist. Although it affects the MCP joints too, in this patient it is not obvious there. This patient also has subluxation of the wrist but is not very clear in this photo.
When assessing such patients, the most important assessment is the functional assessment and not the cosmetic deformity.