A 16-year-old male presents with a few months of worsening joint pain and swelling in his left index, middle, and ring fingers. Other than prior left thumb DIP amputation and left index finger debridement and autograft secondary to excessive outdoor cold exposure in that hand a year and a half ago, he has no known chronic medical problems.
There are joint irregularities and central erosions/subchondral collapse at the 2nd-4th PIP and DIP joints, 5th PIP joint, and the 2nd, 3rd, and 5th metacarpal heads. There is surrounding fusiform soft tissue swelling around the 2nd-5th PIP joints. Bones are osteopenic. Partial amputation changes of the distal thumb.