Rheumatoid Arthritis Initial Assessment

Clinical Presentation

In general, patients with rheumatoid arthritis present with joint pain and/or swelling, morning stiffness lasting for ≥1 hour, myalgia, fatigue, weight loss, low-grade fever, and depression. It typically involves the joints of the fingers, wrists, and toes. It also affects other parts of both the upper and lower extremity joints including the shoulders, elbows, knees, and ankles. The syndrome of polymyalgia rheumatica may occasionally be present.

Early rheumatoid arthritis presents with signs and symptoms of rheumatoid arthritis with a duration of <6 months and meets the classification criteria for rheumatoid arthritis. An established rheumatoid arthritis presents with signs and symptoms of rheumatoid arthritis with a duration of ≥6 months and meets the classification criteria for rheumatoid arthritis.  

Palindromic rheumatism follows an episodic pattern where joints may be affected for hours to days followed by symptom-free periods lasting for days to months.  

Undifferentiated arthritis is in patients with early inflammatory arthritis with a duration of between six weeks to one year and whose that disease cannot be clearly diagnosed or differentiated from other forms of arthritis.  

Extra-articular involvement may be present if there is anemia, fatigue, pleuropericarditis, interstitial lung disease, neuropathy, Sjorgen’s syndrome or vasculitis. There may also be subcutaneous rheumatoid nodules on the extensor surfaces of the elbows and Achilles tendons. Splenomegaly may be present.  

History

It is important to note that joint pain and swelling are the key features of rheumatoid arthritis. Patients may present with a limited or restricted range of motion. Hand and foot involvements are common in the early course of rheumatoid arthritis with wrists that are often involved. Symmetric polyarthritis involving the interphalangeal thumb joints, metacarpophalangeal, and/or proximal interphalangeal joints of the hands, and the metatarsophalangeal joints of the feet strongly suggests rheumatoid arthritis.  

Rheumatoid arthritis - Initial Assessment

Physical Examination

Deformities due to joint and tendon destruction are late manifestations of rheumatoid arthritis and this includes ulnar deviation or drift, radial deviation of the wrist, Boutonnière and swan-neck deformities, hammer toes, joint ankylosis (uncommon), and genu varus or valgus which may also be seen secondary to erosion of the femoral condyles and tibial plateau.

Diagnosis or Diagnostic Criteria

The diagnosis of rheumatoid arthritis is based on the patient’s clinical signs and symptoms, laboratory results, and imaging features. Early diagnosis is essential in disease impact reduction on different systems.