Plain X ray hand PA view shows mild subperiosteal bone resorption affecting radial aspects of the proximal and middle phalanges of the 2nd and 3rd fingers, terminal tuft erosions (acro-osteolysis), as well as spur-like excrescences. Figure shows changes in the carpus closely resembling those of rheumatoid arthritis, radiocarpal and scapho-trapezoid joint arthritis.