37-year old man presented with a 18 month old history of thickened, cracked and painful skin of fingertips of both hands. He also had low grade fevers and muscle weakness. Laboratory testing shows increased levels of creatinine phosphate. DIAGNOSIS: Laboratory tests also show presence of anti body Anti JO-1 and anti SSA were positive, A diagnosis of Anti synthetase syndrome, A type of idiopathic inflammatory myopathy was made, His skin findings are also known as "mechanic hands"