Joint swelling in hands a...

A 74-year-old man with joint swelling in his hands visits the dermatology clinic. A biologic drug is currently being used to treat the patient's persistent skin problem and arthritis. His medical history includes a recent episode of pneumonia and myocardial infarction. His skin is free of erythematous spots or scaling on the scalp, but he has significant distal joint oedema on all ten fingers.