Signs and Symptoms of Rheumatoid Arthritis

Most people with rheumatoid arthritis (RA) experience a gradual onset of symptoms that usually develop over a period of weeks or months. Although the clinical presentation of RA can vary among individuals, there are some predominant symptoms that are common to most patients including joint pain, swelling, tenderness, and morning stiffness usually lasting 1 hour or longer. Other signs and symptoms that may be experienced by patients with RA include:

• Fatigue
• Weakness
• Malaise
• Fever
• Weight loss
• Depression

It is important to note that because RA is a systemic disease, it is not limited to the joints but can also affect other areas of the body including:

• Skin - Bumps under the skin known as rheumatoid nodules develop in about 25% patients with RA.
• Eyes - Approximately 30% of patients with RA also suffer from Sjogren's syndrome - an autoimmune disorder characterized by insufficient production of tears (dry eyes) and saliva (dry mouth).
• Lungs - Lung problems that may develop in some patients with RA include:
  • pleural effusions - excessive accumulation of fluids between the membranes that line the lungs
  • pulmonary fibrosis - scar tissue formation in the lungs which leads to reduced lung function
• Heart - Heart problems that may develop in some patients with RA include:
  • pericarditis - inflammation of the pericardial membrane lining the heart
  • rheumatoid nodules may form on the valves of the heart
• Lymph nodes - Some patients with RA may develop a condition called lymphadenopathy (enlarged, swollen lymph nodes).
• Spleen - Some patients may develop a condition called Felty's syndrome which is characterized by:
  • rheumatoid arthritis
  • splenomegaly (enlarged spleen)
  • lymphadenopathy
  • anemia - abnormally low numbers of red blood cells
  • thromocytopenia - abnormally low numbers of platelets
• Nervous system - Some patients with RA may develop neurological condtions including:
  • peripheral neuropathy - a condition affecting the peripheral nerves of the hands and/or feet characterized by pain, numbness, tingling, and burning
  • cervical instability - loss of the normal architecture of the cervical spine leading to instability and neurological symptoms
• Blood vessels - Some patients with RA develop a condition called vasculitis (inflammation of blood vessels).

Systemic features of RA, however, appear to have become less frequent with the advent of modern, early, intensive treatments for RA.

Diagnostic Evaluation of Rheumatoid Arthritis

The diagnostic "work-up" of patients with suspected rheumatoid arthritis (RA) usually involves the following evaluations:

• Patient history and physical examination
• Laboratory studies
• Imaging studies

Because rheumatoid arthritis (RA) is primarily a clinical diagnosis, the patient history and physical examination are critical for establishing an accurate diagnosis. The patient history focuses of the following areas:

• Chief complaint - What prompted the patient to visit the health care provider at this time?
• Signs and symptoms as described by the patient particularly joint pain, swelling, tenderness, morning stiffness, and fatigue.
• How long have the symptoms been present?
• Severity of the symptoms (mild, moderate, or severe)
• Any medications that the patient may be taking to alleviate the symptoms
• Is the patient experiencing any functional limitations as a result of the symptoms?

The physical examination of patients with suspected RA focuses on the following areas: