Bilateral Finger Swelling in an Adolescent

A 16-year-old boy presented with a 3-month history of increasing swelling of the proximal interphalangeal (PIP) joints of both hands. He had no history of pain, fever, joint stiffness, or skin erythema. Clinical examination revealed bilateral swelling of the PIP joints of the second, third, fourth, and fifth fingers (Figure, A), with no joint tenderness or limitation of movement. Routine laboratory investigations, including complete blood count, C-reactive protein, and erythrocyte sedimentation rate, were normal.

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