A woman aged 52 years, known to have rheumatoid arthritis for 12 years, presented with worsening of joint pain for 2 weeks. Her disease was well-controlled with oral prednisolone and disease-modifying antirheumatic drugs (DMARDs), which she had discontinued for the last 2 months. Examination revealed tender and swollen left shoulder (figure 1A), both wrists, knees, ankles and small joints of hands and feet. Investigations revealed normal haemogram and raised inflammatory markers. Radiographs of hands and left shoulder (figure 1B) showed erosions and joint space narrowing. Grayscale ultrasonography of the left shoulder revealed subacromial subdeltoid bursitis with multiple loose bodies (figure …