Rheumatoid%20arthritis Signs and Symptoms
Introduction
- Rheumatoid arthritis (RA) is a chronic inflammatory arthritis of unknown etiology
- Most common autoimmune inflammatory arthritis in adults
- Persistent synovitis leads to joint destruction and deformity
Signs and Symptoms
General
- Joint pain and/or swelling
- Morning stiffness lasting ≥1 hour
- Myalgia, fatigue, weight loss, low-grade fever, depression
- Typically involves the joints of the fingers, wrists, toes
- Upper and lower extremity joints are also affected (eg shoulders, elbows, knees and ankles)
- Syndrome of polymyalgia rheumatica may occasionally be present
Early Rheumatoid Arthritis
- Duration of occurrence of rheumatoid arthritis signs and symptoms is <6 months and meets the classification criteria of rheumatoid arthritis
Established Rheumatoid Arthritis
- Duration of occurrence of rheumatoid arthritis signs and symptoms is ≥6 months and meets the classification criteria of rheumatoid arthritis
Palindromic Rheumatism
- Follows an episodic pattern
- Joints may be affected for hours to days followed by symptom-free periods lasting for days to months
Undifferentiated Arthritis
- May indicate onset of a polyarticular disease
- Interval between monoarthritis and polyarthritis may extend from days to weeks in patients with progressive disease
- Large joints are frequently affected (eg shoulder, wrist, hip, knee, ankles)
- History of joint trauma may be the initiating event
Extra-articular Involvement
- Anemia, fatigue, pleuropericarditis, interstitial lung disease, neuropathy, scleritis, Sjogren’s syndrome, vasculitis
- Subcutaneous rheumatoid nodules on extensor surfaces of elbows and over Achilles tendons
- Splenomegaly
Etiology
- Smoking increases incidence for developing rheumatoid arthritis in anti-citrullinated protein antibody (ACPA)-positive patients
- Bacteria (eg Escherichia coli, Helicobacter pylori, Mycobacteria, Mycoplasma, Streptococcus), viruses (eg Epstein-Barr virus, rubella, parvovirus) and periodontal disease (Porphyromonas gingivalis) is strongly associated with the occurrence of rheumatoid arthritis