Rheumatoid arthritis begins insidiously in about two-thirds of patients with flu-like symptoms such as:
- Fatigue
- Weakness
- Anorexia (loss of appetite)
- General feeling of illness
Notice. These symptoms may prevail for weeks to months, delaying diagnosis. Rheumatoid arthritis begins acutely in only about 10 percent of patients, with rapid onset of polyarthritis (arthritis of ≥ 5 joints) associated with fever, general symptoms, lymph node and spleen enlargement. It is typical of rheumatoid arthritis that the specific joint symptoms occur symmetrically – that is, bilaterally. However, in about one-third of patients, symptoms may initially be limited to one joint or a few joints. A soft swelling is typical for arthritis, which is caused by an inflammatory joint effusion. In the early phase, the smaller joints (> 2) are mostly affected, such as wrists, proximal and distal interphalangeal joints (finger base or finger middle joints as well as the toe base joints); later, larger joints such as wrists, elbow, shoulder, knee, ankle joints and the cervical spine are also affected. This results in:
- Arthralgia (joint pain) in the morning hours.
- Joint swelling (reddened and heated).
- Pressure painfulness of the joints
- Movement restrictions
- Stiffness of joints – morning stiffness lasting more than 30 (-60)-minutes is almost always a sign of inflammatory joint disease
In the course of the disease, there are progressive (progressive) joint changes and characteristic deformities, which are associated with loss of function and a reduced quality of life. Furthermore, so-called extra-articular (not affecting the joints) organ manifestations are possible. These include:
- Rheumatoid nodules, subcutaneous – subcutaneous, coarse, shifting nodules that form primarily at sites of pressure; develop in 20-30% of patientsTypical locations: Tendons and subcutis (subcutaneous tissue) over bony prominences and extensor sides of the wrist and elbow joint.
- Generalized vasculitis (vascular inflammation).
- Hepatitis (inflammation of the liver)
- Keratomalacia – softening (malacia) with melting and clouding of the cornea of the eye.
- Lymphadenopathy – enlargement of the lymph nodes.
- Lung:
- Pulmonary fibrosis – connective tissue-scarring remodeling of lung tissue.
- Pleurisy (inflammation of the pleura)
- Loosening of ligaments, tendons
- Nail symptoms:
- Yellow fingernail syndrome (yellow-nails; yellow-nail syndrome) – yellowish discolored nails.
- Point-shaped bleeding under the nails
- Perimyocarditis – inflammation of the layers of heart muscle that lie under the inner leaf of the pericardium.
- Polyneuropathy – disease of peripheral nerves.
- Weakness of the skeletal muscles
- Sjögren’s syndrome (group of sicca syndromes) – autoimmune disease from the group of collagenoses, which leads to a chronic inflammatory disease of the exocrine glands, most often the salivary and lacrimal glands; typical sequelae or complications of sicca syndrome are:
- Keratoconjunctivitis sicca (dry eye syndrome) due to lack of wetting of the cornea and conjunctiva with tear fluid.
- Increased susceptibility to caries due to xerostomia (dry mouth) due to reduced salivary secretion.
- Rhinitis sicca (dry nasal mucous membranes), hoarseness and chronic cough irritation and impaired sexual function due to disruption of mucous gland production of the respiratory tract and genital organs.
- Anemia (anemia)
- Thrombocytosis – multiplication of platelets.
According to the German Society for Rheumatology (DGRh) are considered suspicious criteria of rheumatoid arthritis:
- Two or more swollen joints
- Morning stiffness of more than one hour
- Elevated ESR (erythrocyte sedimentation rate) or CRP levels.
- Detection of rheumatoid factors (RF) or autoantibodies to anti-CCP ( (CCP-Ak; CCP-Ak); this may confirm the suspicion of rheumatoid arthritis. Caveat: A negative finding does not exclude the diagnosis of rheumatoid arthritis.
