Early symptoms of rheumatoid arthritis

Rheumatoid arthritis is a type of arthritis. Different diseases have different symptoms and causes. Therefore, the treatment methods are definitely different, but generally speaking, diseases need to be discovered in the early stages to be more beneficial for us to treat. Therefore, understanding the early symptoms of rheumatoid arthritis is also an important part of treating rheumatoid arthritis. Understanding the cause of the disease can better prevent it.

Different diseases bring us different causes of symptoms and the ways they affect our lives. No matter what the differences are, we should not worry too much about the symptoms as long as they are solvable. The symptoms of the disease also vary according to the physical constitution of different people. So what are the early symptoms of rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic, systemic disease of unknown etiology characterized by inflammatory synovitis. It is characterized by polyarticular, symmetrical, invasive arthritis of the small joints of the hands and feet, often accompanied by extra-articular organ involvement and positive serum rheumatoid factor, which can lead to joint deformities and loss of function.

Clinical manifestations

1. People who are prone to it

It is more common in women, with an incidence rate 2 to 3 times that of men. It can occur at any age, with the peak age being 40 to 60 years old.

2. Symptoms and signs

It may be accompanied by systemic symptoms such as weight loss, low-grade fever and fatigue.

(1) Morning stiffness is the subjective feeling of inflexibility of joints 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

Symmetric 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 Joint deformity

Hand deformities 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. ③Others

There may be carpal tunnel/tarsal tunnel syndrome caused by compression of the median nerve/posterior tibial nerve, fluid accumulation in the knee joint cavity squeezing into the posterior side of the joint to form a popliteal cyst (Baker cyst), involvement of the cervical spine (most commonly the 2nd and 3rd cervical vertebrae) may cause neck pain, neck weakness and difficulty in maintaining its normal position, atlantoaxial joint subluxation, and corresponding manifestations of spinal cord compression and vertebral basilar artery insufficiency.

(3) Extra-articular manifestations ① General manifestations

There may be fever, rheumatoid nodules (which are organizing granulomas, associated with high titer RF, severe joint destruction and RA activity, and are prone to occur in joint prominences such as the elbows, olecranon processes, sacrum, and other areas of frequent pressure), rheumatoid vasculitis (necrotizing arteritis that mainly affects small arteries, which can manifest as necrosis of the finger and toe tips, skin ulcers, peripheral neuropathy, etc.) and lymphadenopathy. ② Heart involvement

Symptoms may include pericarditis, pericardial effusion, epicardial, myocardial and valvular nodules, myocarditis, coronary arteritis, aortitis, conduction disorders, chronic endocarditis and valvular fibrosis. ③Respiratory system involvement

There may be pleurisy, pleural effusion, pulmonary arteritis, interstitial lung disease, nodular lung disease, etc. ④ Renal manifestations

The main types include primary glomerular and tubulointerstitial nephritis, renal amyloidosis and renal damage secondary to drug treatment (gold preparations, penicillamine and NSAIDs). ⑤ Nervous system

In addition to the symptoms of peripheral nerve compression, it can also induce neurological diseases, myelopathy, peripheral neuropathy, ischemic neuropathy secondary to vasculitis, muscle hypertrophy and drug-induced nervous system diseases. ⑥Anemia

It is the most common extra-articular manifestation of RA and is anemia of chronic disease, which is usually mild to moderate. ⑦ The digestive system may be caused by RA vasculitis, complications or drug treatment. ⑧Eye

Young 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.

(4) Felty syndrome

1% of RA patients may have splenomegaly, neutropenia (and thrombocytopenia, decreased red blood cell count), often with severe joint lesions, high titer RF and ANA positivity, which is a severe type of RA.

(5) Remitted seronegative, symmetrical synovitis

RS3PE is more common in men, usually after the age of 55, with acute onset, symmetrical inflammation of the wrist joints, flexor tendon sheaths and small joints of the hands, and pitting edema on the back of the hands. Morning stiffness lasts for a long time (0.5 to 1 day), but RF is negative and X-rays often show no bone destruction. 56% of the patients were HLA-B7 positive. The patient responds poorly to NSAIDs alone, but low-dose glucocorticoids are effective. It usually resolves spontaneously after 1 year and has a good prognosis.

(6) Adult-onset Still's disease (AOSD)

A rare type of RA characterized by alternating acute attacks and remissions of high fever, arthritis, and rash. It is named because its clinical manifestations are similar to systemic juvenile rheumatoid arthritis (Still's disease). Some patients develop typical RA after several attacks.

(7) Elderly-onset RA

The disease usually starts at age > 65, with little gender difference. It is often acute and progresses rapidly (some patients have OA as the initial manifestation, and typical RA symptoms appear a few years later). The prominent manifestations are hand and foot edema, carpal tunnel and tarsal tunnel syndrome, and polymyalgia, with obvious morning stiffness. 60% to 70% of RF are positive, but the titer is mostly low. X-rays show mainly osteoporosis, with few invasive changes. Patients often die from complications such as cardiovascular, infection and impaired renal function. NSAIDs should be selected with caution. Small doses of hormones can be used, and the response to slow-acting antirheumatic drugs (SAARD) is better.

The above introduces the early symptoms of rheumatoid arthritis. Only by correctly understanding its symptoms can we better treat the harm caused by these diseases. Generally, if you experience symptoms such as weight loss, low fever, and general fatigue, you should pay more attention. As long as your body shows symptoms that are different from usual, you should seek timely treatment, as this will increase the chances of recovery.