Nonspecific prodromal symptoms that develop insidiously over weeks to months may include fatigue, weakness, low-grade fever, loss of appetite, and joint pain. Stiffness and myalgias may precede development of synovitis.
Joint involvement tends to be symmetric and affect the small joints of the hands, wrists, and feet; the elbows, shoulders, hips, knees, and ankles may also be affected.
Joint stiffness typically is worse in the morning, usually exceeds 30 minutes, and may persist all day.
On examination, joint swelling may be visible or may be apparent only by palpation. The tissue feels soft and spongy and may appear erythematosus and warm, especially early in the course of the disease.
Chronic joint deformities commonly involve subluxations of the wrists, metacarpophalangeal (MCP) joints, and proximal interphalangeal (PIP) joints (swan-neck deformity, boutonniere deformity, ulnar deviation).
Extra-articular involvement may include rheumatoid nodules, vasculitis, pleural effusions, pulmonary fibrosis, ocular manifestations, pericarditis, cardiac conduction abnormalities, bone marrow suppression, and lymphadenopathy.
Joint involvement tends to be symmetric and affect the small joints of the hands, wrists, and feet; the elbows, shoulders, hips, knees, and ankles may also be affected.
Joint stiffness typically is worse in the morning, usually exceeds 30 minutes, and may persist all day.
On examination, joint swelling may be visible or may be apparent only by palpation. The tissue feels soft and spongy and may appear erythematosus and warm, especially early in the course of the disease.
Chronic joint deformities commonly involve subluxations of the wrists, metacarpophalangeal (MCP) joints, and proximal interphalangeal (PIP) joints (swan-neck deformity, boutonniere deformity, ulnar deviation).
Extra-articular involvement may include rheumatoid nodules, vasculitis, pleural effusions, pulmonary fibrosis, ocular manifestations, pericarditis, cardiac conduction abnormalities, bone marrow suppression, and lymphadenopathy.
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