Symptoms Of Rhematoid Arthritis

Symptoms:

Although rheumatoid arthritis can have many different symptoms, joints are always affected. Rheumatoid arthritis almost always affects the joints of the hands (such as the knuckle joints), wrists, elbows, knees, ankles, and/or feet. The larger joints, such as the shoulders, hips, and jaw may be affected.]

 The vertebrae of the neck are sometimes involved in people who have had the disease for many years. Usually at least two or three different joints are involved on both sides of the body, often in a symmetrical (mirror image) pattern. The usual joint symptoms include the following:

Stiffness: The joint does not move as well as it once did. Its range of motion (the extent to which the  appendage of the  joint,     such as the arm, leg, or finger, can move in different directions) may be reduced. Typically, stiffness is most   noticeable in the morning and improves later in the day.

 Inflammation: Redness, tenderness, and warmth are the hallmarks of inflammation.

 Swelling: The area around the affected joint is swollen and puffy.

 Nodules: These are hard bumps that appear on or near the joint. They often are found near the elbows. They are   most   noticeable on the part of the joint that juts out when the joint is flexed.

 Pain: Pain in rheumatoid arthritis has several sources. Pain can come from inflammation or swelling of the joint and surrounding tissues or from working the joint too hard. The intensity of the pain varies by the individual. These symptoms may keep us from being able to carry out our normal activities. General symptoms include the following:

 fever, fatigue,  loss of appetite, weight loss, myalgias (muscle aches), and weakness or loss of energy.

 The symptoms usually come on very gradually, although in some people they come on very suddenly. Sometimes, the general  symptoms come before the joint symptoms, and you may think you have the flu or a similar illness.

·            Symptoms usually have gradual onset and may last for years

• Constitutional symptoms may precede articular involvement: fatigue (especially early afternoon), malaise, loss of appetite,

• Typically affects small joints in hands and feet; these joints are usually the first joints affected

• Wrist, elbow, neck, shoulder, hip, and ankle joints may also be involved

• Initial articular manifestations: swelling/effusion, restricted motion, warmth

• Stiffness, lasting more than 1 hour, especially after sleep or rest

• Swollen glands

• Burning or itching sensation in eyes; inflammation

• Pallor

• Numbness or tingling

• Leg ulcers

• Shortness of breath

Signs:

• Typically affects small joints in hands (except distal interphalangeal joints) and feet; these joints are usually the first joints affected. Wrist, elbow, neck, shoulder, hip, and ankle joints may also be involved

• Lumbar or thoracic spine not affected

• Multiple, symmetric involvement is typical

• Rheumatoid nodules: painless, subcutaneous nodules over bony prominences (e.g. the elbow and shaft of the ulna) in 20- 30% of patients.

• Chronic inflammation of the tendon sheaths

• Eventual characteristic deformities include subluxations, dislocations, and joint contractures

• Possible tendon rupture

• Low-grade fever may be apparent

• Swollen lymph glands

• Anemia

• Leg ulcers

• Splenomegaly

Associated disorders

• Depression: living with arthritis can cause depression in some patients

• Interstitial lung disease and S jögren's syndrome

• Septic arthritis: rheumatoid arthritis patients are at increased risk of septic arthritis because they have abnormal joints and are often on immunosuppressive drugs.

  Differential diagnosis:

• Rheumatoid arthritis (RA) can be very difficult to diagnose, especially in early disease

• If there is any uncertainty over diagnosis, referral to a rheumatologist is strongly indicated

• Systemic lupus erythematosus, psoriatic arthritis, and spondyloarthropathies may mimic RA

Septic arthritis

•Septic arthritis is highly destructive; referral is essential if suspected.

Features:

• Usually affects one joint (monoarthritis) - most often knee or hip

• Affected joint(s) hot, painful and swollen, with restricted range of movement

• Fever often present

• Also suspect in patient with established RA who develops an acute flare, especially after local corticosteroid therapy

• Often caused by spread of infection from a distant site, direct puncture of the joint, or spread from adjacent osteomyelitis

• Often associated with history of previously abnormal joint, RA, old age, immunocompromised status, or intravenous drug use

• Synovial fluid contains >50,000 WBCs/mm3

• Synovial fluid positive for culture and Gram stain

• Causes no early radiographic abnormality

•  If untreated, can lead to irreversible joint damage

Osteoarthritis-Erosive osteoarthritis may coexist with RA in the elderly. It affects the distal interphalangeal joints (DIPs), which are not affected by RA.

Features

•X-rays display typical joint space narrowing, subchondral sclerosis, and osteophytic spurring. More abnormality at the interfaces of the phalanges is seen compared with typical osteoarthritis

•Joints show soft tissue inflammation, bony swelling, crepitus, and restricted movement

•Slowly progressive with occasional exacerbations, which may be associated with warmth and redness. Effusion may be present

•Affects one or a few joints, typically those that are weight-bearing or have suffered previous injury

•Only rarely affects the wrist

•Erythrocyte sedimentation rate (ESR) normal

•No systemic illness

•Synovial fluid noninflammatory (<2000 white blood cells (WBCs)/mL)