Clinical manifestations of rheumatoid arthritis
- PJW Venables, MA, MB BChir, MD, FRCP
PJW Venables, MA, MB BChir, MD, FRCP
- Professor of Viral Immunorheumatology
- Kennedy Institute, Oxford University
- Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
- Section Editor — Rheumatoid Arthritis
- Emeritus Professor of Rheumatology, Imperial College London
- Visiting Professor, Oxford University
Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder of unknown etiology that primarily involves synovial joints. The arthritis is typically symmetrical, and usually leads, if uncontrolled, to destruction of joints due to erosion of cartilage and bone, causing joint deformities. The disease usually progresses from the periphery to more proximal joints and results in significant locomotor disability within 10 to 20 years in patients who do not fully respond to treatment.
The major clinical features of RA, including the articular manifestations, are reviewed here. The systemic and nonarticular features and the diagnosis and differential diagnosis of RA are discussed in detail separately. (See "Overview of the systemic and nonarticular manifestations of rheumatoid arthritis" and "Diagnosis and differential diagnosis of rheumatoid arthritis".)
INITIAL CLINICAL PRESENTATION
Rheumatoid arthritis (RA) most typically presents as polyarticular disease and with a gradual onset, but some patients can present with acute onset with intermittent or migratory joint involvement or with monoarticular disease. (See 'Typical "classic" RA' below and 'Palindromic rheumatism' below and 'Monoarthritis' below.)
The symptoms of arthritis can affect the patient’s capacity to perform the activities of daily living (eg, walking, stairs, dressing, use of a toilet, getting up from a chair, opening jars, doors, typing) and their ability to do their job.
Systemic symptoms may also be present in these patients; in up to one-third of patients, the acute onset of polyarthritis is associated with prominent myalgia, fatigue, low-grade fever, weight loss, and depression. Less often, extraarticular manifestations such as nodules or episcleritis may also be present. (See 'Extraarticular involvement' below.)
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- INITIAL CLINICAL PRESENTATION
- Articular disease
- - Typical "classic" RA
- - Palindromic rheumatism
- - Monoarthritis
- Extraarticular involvement
- SYMPTOMS AND PHYSICAL FINDINGS
- Physical findings of joint inflammation
- Distribution of involved joints
- Upper extremity
- - Hands
- - Wrists, elbows, and shoulders
- Lower extremity
- Axial skeleton
- Cricoarytenoid joint
- LABORATORY FINDINGS
- Plain film radiography
- CLINICAL COURSE
- Patterns of progression
- Disease activity versus structural damage
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS