Symptoms and clinical manifestations of rheumatism and rheumatoid arthritis

Rheumatoid arthritis and rheumatic diseases are completely different. Rheumatoid arthritis will cause fever, headache, and joint pain, which are very common among women and middle-aged and elderly people. Patients will also experience symptoms of weight loss, and the cause needs to be found and treated in time.

1. Morning stiffness is the subjective feeling of inflexible joint movement when getting up in the morning. It is a non-specific manifestation of joint inflammation, and its duration is proportional to the severity of the inflammation.

2. Manifestations of joint involvement ① Multiple joint involvement presents as symmetrical polyarthritis (usually ≥ 5 joints). The joints that are easily affected include the hands, feet, wrists, ankles and temporomandibular joints, and others may include the elbows, shoulders, cervical vertebrae, hips, knees, etc. ② The deformities of the hand with joint deformity include fusiform swelling, ulnar deviation, swan neck deformity, buttonhole deformity, etc. Foot deformities include calcaneal deformity caused by downward subluxation of the metatarsal head, valgus deformity, metatarsophalangeal joint subluxation, hammer toe and valgus deformity. ③Other conditions may include carpal tunnel/tarsal tunnel syndrome caused by compression of the median nerve/posterior tibial nerve, fluid accumulation in the knee joint cavity that squeezes into the posterior side of the joint to form a popliteal cyst (Baker cyst), involvement of the cervical vertebrae (most commonly the 2nd and 3rd cervical vertebrae) with neck pain, neck weakness and difficulty in maintaining a normal position, atlantoaxial subluxation, and corresponding manifestations of spinal cord compression and vertebral basilar artery insufficiency.

3. Extra-articular manifestations ① General manifestations may include fever, rheumatoid nodules (organizing granulomas, associated with high titer RF, severe joint destruction and RA activity, prone to occur in elbows, olecranon processes, sacrum and other joint prominences and areas frequently subjected to pressure), rheumatoid vasculitis (mainly necrotizing arteriolar inflammation involving small arteries, which may manifest as necrosis of the finger and toe tips, skin ulcers, peripheral neuropathy, etc.) and lymphadenopathy. ② Heart involvement may include pericarditis, pericardial effusion, epicardial, myocardial and valvular nodules, myocarditis, coronary arteritis, aortitis, conduction disorders, chronic endocarditis and valvular fibrosis. ③ Involvement of the respiratory system may include pleurisy, pleural effusion, pulmonary arteritis, interstitial lung disease, nodular lung disease, etc.

④ Renal manifestations mainly include primary glomerular and tubulointerstitial nephritis, renal amyloidosis and renal damage secondary to drug treatment (gold preparations, penicillamine and NSAIDs). ⑤ In addition to the symptoms of peripheral nerve compression, the nervous system can also induce neurological diseases, spinal cord disease, peripheral neuropathy, ischemic neuropathy secondary to vasculitis, muscle hypertrophy and drug-induced nervous system diseases. ⑥ Anemia is the most common extra-articular manifestation of RA. It is anemia of chronic disease and is usually mild to moderate. ⑦ The digestive system may be caused by RA vasculitis, complications or drug treatment. ⑧Young patients may have uveitis and adults may have scleritis, which may be caused by vasculitis. There may also be sicca conjunctivitis keratitis, scleral softening, scleral softening perforation, and corneal dissolution.