Arthritis Arthritis Basics

The Clinical Aspects of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a highly individualized condition that acts differently in each patient. Typically, the signs and symptoms begin slowly over a period of weeks to several months. However, in about 10 to 15 percent of patients, the disease may start suddenly with the inflammation and swelling of several joints developing very quickly. It is important that patients seek professional care immediately when this happens to rule out the possibility that other causes may be at work.

Rheumatoid arthritis is a chronic disease, but it is not always actively causing symptoms. In fact, the symptoms often disappear, the tissue inflammation subsides and patients generally report feeling well. These periods of remission can occur spontaneously or be the result of treatment. They can last for weeks, months or even years.

When the disease becomes active again, the symptoms can return, sometimes with a vengeance. The return of disease activity and symptoms is called a flare.

Signs and Symptoms
The most common symptoms associated with rheumatoid arthritis are pain and swelling that usually occur in several joints at the same time. During the early stages of the disease, the wrists, hands, feet and knee joints are most often affected.

A telltale sign of rheumatoid arthritis is a symmetrical pattern of joint inflammation. That means joints on both sides of the body, such as the knuckles on both hands or the small joints in both feet, are affected simultaneously.

As the disease progresses, the joints in the shoulders, elbows, hips, jaw and neck may become involved. Eventually, the pain, swelling and resulting joint deformities lead to loss of motion because the joints don't move as well as they used to. It also causes a loss of strength in the muscles that are attached to the affected joints

In about 25 percent of patients, firm lumps called rheumatoid nodules will pop up beneath the skin at various pressure points. They can appear at the elbows, hands, feet and Achilles tendons, or they may show up at the back of the scalp, over a knee or in the lungs. These nodules, which occur in fewer than 10 percent of patients during the first year of disease, are usually not painful. They normally range in size from being as small as a pea to as large as a walnut.

A generalized feeling of aching or stiffness in the joints and muscles is also common. This usually occurs in the morning after sleep or following periods of rest. The morning stiffness may last anywhere from one to two hours or as long as the entire day. This is an important characteristic of active rheumatoid arthritis as most other arthritic diseases do not behave this way.

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