Rheumatoid arthritis primarily is a clinical diagnosis. Patients commonly present with pain and stiffness in multiple joints, although one third of patients initially experience symptoms at just one location or a few scattered sites. In most patients, symptoms emerge over weeks to months, starting with one joint and often accompanied by prodromal symptoms of anorexia, weakness, or fatigue. In approximately 15 percent of patients, onset occurs more rapidly over days to weeks. In 8 to 15 percent of patients, symptoms begin within a few days of a specific inciting event, such as an infectious illness.
There are many forms of arthritis (over 100 have been described so far, and the number is growing). The forms range from those related to wear and tear of cartilage (such as osteoarthritis) to those associated with inflammation as a result of an overactive immune system (such as rheumatoid arthritis). Together, the many forms of arthritis make up the most common chronic illness in the United States. Arthritis sufferers include men and women, children and adults. More than half of those with arthritis are under 65 years of age. A majority of Americans with arthritis are women. There are over 100 types of arthritis. It is a common misconception that arthritis is just an old-person's disease.
Do you have symptoms of arthritis?
Joints most commonly affected are those with the highest ratio of synovium to articular cartilage. The wrists are nearly always involved, as are the proximal interphalangeal and metacarpophalangeal joints. The distal interphalangeal joints and sacroiliac joints tend not to be affected.
- Rheumatoid joints typically are boggy, tender to the touch, and warm, but they usually are not erythematous
- Some patients complain of “puffy” hands secondary to increased blood flow to inflamed area
- Epitrochlear, axillary, and cervical lymph nodes may be prominent
- Muscles near inflamed joints often atrophy
- Weakness is commonly out of proportion to pain on examination
- Morning stiffness lasting at least 45 minutes after initiating movement is common
- Patients often hold joints in flexion to minimize painful distension of joint capsules
- Low-grade fever, fatigue, malaise, and other systemic complaints may arise