He denies fever and worsening joint pain. Function of the finger remains normal. He has a history of hypertension and rheumatoid arthritis. He had bilateral total knee replacements three years ago. His current medications include nifedipine, doxazosin, aspirin, salsalate, methotrexate, and prednisone.
Immunizations are current.
The rest of his review of systems is noncontributory. The vital signs are normal. The right hand examination reveals a 3 X 5 millimeter subungal hematoma at the nail base margin with a 5 X 7 millimeter area of surrounding pus. The patient has mild tenderness to palpation over the nail. He has a 7 X 9 millimeter subcutaneous nodule near the distal interphalangeal joint.