All are true about the condition except?

The image shows nodules on extensor distribution along with peripheral smear showing presence of normocytic anemia. The first differential to be considered is rheumatoid ahritis. The nodules are non-tender and are a late feature and hence not considered in diagnostic criteria for Rheumatoid ahritis. "Piano-key movement" of the ulnar styloid occurs due to inflammation about the ulnar styloid and tenosynovitis of the extensor carpi ulnaris. "Z-line deformity" is due to subluxation of the first MCP joint with hyperextension of the first interphalangeal (IP) joint due to damage to the tendons, joint capsule.