What's causing these green and gold nails?
Earl is 78; he retired from the public service more than 20 years ago because of his rheumatoid arthritis.
He received what was conventional treatment at the time but unfortunately the disease progressed.
Now he is very disabled in spite of bilateral knee joint replacements.
He was a heavy cigarette smoker until his mid-50s and has had symptoms of COPD for some time.
Today he is brought into the surgery in a wheelchair, his joints are painful and he is dyspnoeic on modest exertion.
Your examination shows many painful, swollen joints, including the thumbs, wrists, shoulders, knees and ankles.
There is brawny non-pitting oedema of