Symptoms and signs of rheumatoid arthritis

Rheumatoid arthritis is a systemic and autoimmune disease that occurs when the immune system focuses predominantly on the joints, less frequently on other organs, and causes a chronic inflammatory process. The disease most often affects women and usually occurs in the most productive adult period, reaching its peak between the ages of 35 and 50.

Rheumatoid arthritis is a systemic disease because in addition to affecting the joints, it can also affect other organs. Thus, the clinical picture of rheumatoid arthritis includes articular manifestations (symptoms and signs in the joints) and extraarticular manifestations (symptoms and signs occurring in other organs and organ systems).

The main feature of rheumatoid arthritis is inflammation of the joints, namely inflammation of their synovial membrane (connective tissue that coats the inner surface of the joints), known as synovitis. Most often the onset of the disease is polyarticular (affects more than 4 joints), less commonly oligoarticular (affects 2 to a maximum of 4 joints) or monoarticular (affects only one joint). It is typical that the grip is symmetrical, so inflammation of both knees, both shoulders or wrists occurs.

If inflammation is present in a certain joint, then it is clinically manifested by:

1.Swelling. Swelling often occurs in affected and inflamed joints from RA. The cause is thought to be a combination of processes, which include proliferation and hypertrophy of the synovial membrane, accumulation of inflammatory synovial fluid, and thickening of the joint capsule.
2.Pain. Pain is the most common symptom of rheumatoid arthritis. The pain is thought to have originated in the joint capsule, which is richly supplied with painful nerve fibers. If a person suffers from this disease, then it is more or less constantly present. It is emphasized during movement, ie during distension and stretching of the affected joints. It can be an indicator of which joints are affected, but the intensity of the pain does not correlate with the degree of inflammation.
3.Stiffness. Morning stiffness is one of the main features of this disease. It is a feeling of stiffness in sore joints, which can last from one to several hours during the day. Once this subsides, only then will the patient be able to perform daily activities. This unpleasant symptom is thought to be due to the accumulation of fluid in the inflamed tissues of the joint during sleep. The longer the morning stiffness lasts, the more active the disease.
4.Heat. Heat can occur in some of the affected large joints such as the knee. The onset of fever is thought to be due to synovitis (inflammation of the synovial membrane).
5.Redness. Local redness occurs in rare cases and is usually accompanied by pain and swelling of the affected joint.

During its evolution, rheumatoid arthritis can affect virtually all joints including:

-Interphalangeal and wrist joints. These are the most commonly affected joints in RA. The changes in the small joints of the wrists are mainly symmetrical, accompanied by swelling and pain, due to which the restriction of movement is expressed.
-Elbow joint. Inflammation of the synovial membrane of the elbows at an early stage of the disease leads to weakening of the ligaments that attach the joint. Very often, people who suffer from RA and have inflammation of the elbow joints, do not even notice that they can not make a full extension of the elbow, ie bring the forearm to an anatomical position.
-Flat wrist. The shoulder joints are most commonly affected and affect about 50% of patients, and up to 80% of older men. The main symptoms are pain, especially at night and limited movements. Swelling rarely occurs in the shoulder joint.
-Foot and ankle. These joints are affected in the early stages with approximately the same prevalence as the wrist joints. The front part of the foot is most often affected, swelling, pain and restriction of movement are present. As the disease progresses, the toes expand outward and inward, resulting in deformities of the feet such as hallux valgus and toe.
-Knee. The knee is one of the most commonly affected joints in rheumatoid arthritis. It occurs in about 30% at an early stage of the disease. Pain, swelling and restriction of movement are the discomforts that occur during the inflammatory process of the knee.
-How much. The clinical manifestation of rheumatoid arthritis of the hip does not occur at an early stage of the disease. However, about 20% of patients have significant progression of hip disease which is a major disability. The main features of hip infection are pain and painful tenderness to the touch, aggravated by and tilt when walking.
-Jaw (Temporomandibular) joint. The jaw joint is changed in 50% of patients. If this joint is affected, then the patient feels numbness and pain, which is especially pronounced when touched, and very often the pain is so great that the person can not open his mouth.
-Intervertebral joints. Changes in the joints of the spine can lead to headaches, tingling in the arms and legs, or in extremely rare cases, due to compression of the spinal cord, sphincter incontinence. As the disease progresses, it can irritate the blood vessels that feed the intervertebral joints, which can lead to vomiting, difficulty swallowing, viewing double images, and transient loss of vision.

Although RA predominantly occurs in women, when it comes to extraarticular symptoms and signs, they are more common in men.

Extraarticular manifestations include:
1.Cutaneous manifestations. Rheumatoid nodules are the most common cutaneous manifestation of RA and are present in 20-30% of patients. They are solid subcutaneous formations that occur mainly on surfaces exposed to mechanical pressure, such as the interphalangeal joints, elbows, and Achilles tendon. Rarely, rheumatoid nodules may occur in the lungs, meninges, myocardium, and pericardium and present symptomatologically depending on location.
2.Haematological manifestations. Anemia occurs in almost every person suffering from RA at a certain stage of the disease. Causes of RA anemia may include difficulty absorbing iron by erythrocytes, decreased resorption, decreased erythropoiesis, reduced erythrocyte lifespan, or microbleeding in the gastrointestinal tract. Anemia correlates with the activity of the disease, ie it intensifies with worsening and subsides with improvement of RA. It is especially important to know that rheumatoid anemia does not respond to the usual treatments for anemia, in fact the treatment is indirect, through the treatment of RA. In addition to anemia, neutropenia, thrombocytopenia, or thrombocytosis may occur.
3.Pulmonary manifestations. Pulmonary fibrosis, inflammation of the pleura, and rheumatoid nodules in the lungs are just some of the many manifestations of RA in the respiratory system.
4.Renal manifestations. Kidney disorders such as glomerulonephritis occur in 40% of patients. Their occurrence can often be problematic, as it is difficult to determine whether they are an integral part of the disease or the result of the therapy given to treat RA.
5.Eye manifestations. Ocular manifestations include episcleritis and scleritis, or inflammation of the sclera. The symptoms can be of varying intensity and very rarely lead to blindness.
6.Cardiovascular manifestations. The most common manifestation of RA from the cardiovascular system is pericarditis, ie inflammation of the pericardium (heart lining). Symptoms of pericarditis may include severe, stabbing chest pain, shortness of breath, and tachycardia.
7.Neurological manifestations. Peripheral neuropathy is a neurological manifestation and occurs in a small proportion of RA patients. The cause of this complication is the development of vasculitis of the small blood vessels that feed the nerves, causing demyelination and ischemic neuropathy. Symptoms of peripheral neuropathy include pain in the feet and lower leg, tingling, stinging, and burning sensations, decreased or increased sensitivity to touch, restless legs syndrome, muscle weakness, and so on.

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