Question category: Rheumatology
A 58 year old gentleman presents with pain in his hands. He states in it his second and third fingers on both hands which are affected. On examination there is evidence of swelling and stiffness in his second and third MCPs on both hands although there is no evidence of warmth or erythema. On further questioning he states he has been fatigued and is having trouble with impotence. He has no other past medical history but does admit to drinking excessively at times. On further examination he appears very suntanned and there is hepatomegaly. His bloods reveal deranged LFTs.