![]() ![]() Prolonged morning joint stiffness is highly suggestive of inflammatory arthritis as distinct from the transient stiffness of osteoarthritis, which lasts a few minutes only. In more elderly patients, RA may present as steroid-responsive polymyalgia rheumatica and the more typical peripheral, symmetrical arthritis of established RA may only become apparent once the steroid dose is weaned down. Another is a so-called ‘palindromic’ presentation, in which transient symptoms arise in few joints over days to weeks before completely resolving, only to recur later in the same or other joints and tending to increase over time. These include an acute, explosive, polyarticular onset which may arise overnight or over the course of a few days. Other less common articular patterns of RA presentation may also occur. The cervical vertebrae may also become involved while the spine is otherwise unaffected. In many individuals, large joints are also affected including the shoulders, elbows, knees and ankles. Patients may report that they feel as if they are walking on pebbles and that they have difficulty in making a full fist in the morning. The joint distribution frequently involves the metacarpophalangeal (MCP) and proximal interphalangeal joints of the hands, typically with sparing of the distal interphalangeal joints, the wrists, and metatarsophalangeal (MTP) joints of the feet. Over time, the pattern may become more persistent and tends to evolve into symmetrical, polyarticular involvement (comprising five or more joints). ![]() These may include stiffness in one or more joints, often most marked in the morning, accompanied by discomfort on movement and joint tenderness. ![]() RA often begins insidiously, with slow development of signs and symptoms, which may vary in intensity, over many weeks. Women are affected about twice as commonly as men in the UK. It may begin at any age with a wide spectrum of onset, although patients most commonly present from the sixth decade onwards with a peak incidence between 70 and 80 years of age. The clinical presentation of RA is heterogeneous, as is the subsequent disease course. ![]()
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