RHEUMATOID ARTHRITIS – SIGNS AND SYMPTOMS

The onset of disease is usually slow and starts with loss of appetite, weakness, feverishness and a sense of being unwell. These vague symptoms may be present for weeks before appearance of specific joint symptoms. In some patients the onset of disease may be faster and joint symptoms may appear early along with the general symptoms.

Articular (joint) manifestations:

  • Pain, swelling and stiffness of joints – pain which increases with movement is the most common symptom. Stiffness  (limitation of movement) of the involved joint after a period of inactivity (morning stiffness), lasting for more than one hour is a distinguishing feature of rheumatoid arthritis.

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  • Symmetric and multiple joint involvement – Involvement of more than three joints at a time (polyarthritis) and same joints on both sides of the body (symmetrical) is characteristic of rheumatoid arthritis.
  • Joints of the hand especially the finger joints close to the wrist (metacarpophalangeal and proximal interphalangeal joints) are very often involved. The finger joints away from the wrist (distal interphalangeal joints) are frequently spared. Other commonly involved joints may include the wrist, knee, ankle, toe and elbow.
  • Functional loss is characterised by the inability to make a fist, weakened grip, inability to hold/pinch objects. With further progression of the disease, muscles and tendons become rigid and remain in a state of sustained contraction (flexion contractures) as a result of which the joint becomes fixed.
  • Movement at the joints is limited and deformity of the joints sets in with progress of the disease. Commonly noticed deformities include deviation of fingers toward the little finger (ulnar deviation), appearance of fingers as if holding a sewing needle (boutonniere’s deformity), deformity of the neck that makes it resemble the neck of a swan (swan neck deformity), deviation of the toes towards the little toe, cocked-up toes and outward turned foot (eversion).

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Extra-articular (away from the joint) manifestations:

  • Subcutaneous (beneath the skin) nodules (Rheumatoid nodule) found on the backside (extensor surface) of  arms and elbows, back of neck.
  • Lymph node enlargement
  • Reddish spots (hemorrhagic spots) along the nail beds, nail folds, pulp of the finger and skin ulcers.  
  • Red and painful eyes (Scleritis) or lack of tears (Sjogren’s syndrome).
  • Lung involvement may manifest as cough and breathlessness (as a result of accumulation of fluid between the membranes covering the lungs i.e. pleura).
  • Chest pain and difficulty in breathing may occur due to involvement of heart (as a result of accumulation of fluid between the membranes covering the heart i.e. pericardium).