I did not see hands deformed like this very often in the U.S. Here I see them every week. The changes are a consequence of rheumatoid arthritis. Rheumatoid arthritis has gone from being something I felt a little unsure treating, to something I treat without even glancing at a book. Most of the time people get better with simple medications, but there are unresponsive cases, and I often wish I had better access to some of the treatments available in the states. But I am so glad and thankful that we can help so many with what we have.