Articular manifestations of rheumatoid arthritis

The clinical course of RA is extremely variable. In most patients, the disease begins insidiously with malaise, fatigue, non-localised musculoskeletal pain, and sometimes low grade fever.

Only later do joints become involved, sometimes monarticular, at other times oligoarticular, and in some instances polyarticular (usually symmetrically). Often the disease begins in the proximal finger joints and wrists and later spreads to the elbows, shoulders, knees, ankles and feet. Characteristic deformities occur and include, in the hands, ulnar deviation of the fingers due to subluxation at the metacarpophalangeal joints, loss of finger function due to hyperextension of the PIP joints with fixed flexion of the DIP joints 'swan neck deformity', or fixed flexion of the PIP joints with hyperextension of the DIP joints 'boutonniere' or Z deformity of the thumb.

Typically:

• local swelling, redness and pain
• stiffness following inactivity
• characteristic deformities of the hand and wrist
• extra-articular manifestations, for example, rheumatoid nodules, Sjogren's syndrome, pleurisy, vasculitis, peripheral neuropathy