<prompt> All are true about the condition except?Piano key movement of ulnar styloidZ line deformityAtlanto axial deformityTender Nodes  <response>: The image shows nodules on extensor distribution along with peripheral smear showing presence of normocytic anemia. The first differential to be considered is rheumatoid ahritis. The nodules are non-tender and are a late feature and hence not considered in diagnostic criteria for Rheumatoid ahritis. Piano-key movement of the ulnar styloid occurs due to inflammation about the ulnar styloid and tenosynovitis of the extensor carpi ulnaris. Z-line deformity is due to subluxation of the first MCP joint with hyperextension of the first interphalangeal IP joint due to damage to the tendons, joint capsule. 