Patients presenting to the rheumatologist are asked questions designed to elicit specific information. Since there are more than 100 different types of arthritis, it is important to get a good, accurate history of symptoms.
The most common symptoms are morning stiffness, joint pain and swelling, nodules under the skin in about 20% of patients, and fatigue.
The duration of morning stiffness generally exceeds one hour and often extends all day. Stiffness during the day may also occur if a patient sits for any length of time.
Joint swelling and pain affects both small as well as large joints in a symmetric fashion. Early on, small joints such as the hands, wrists, and feet are affected. As the disease progresses other joints become involved as well. Becasue patients vary in terms of pain tolerance, it may be necessary to ask relatives about a patient's pain symptoms. Questions regarding their ability to perform activities of daily living can provide valuable clues.
Fatigue is often profound and debilitating.
Since rheumatoid arthritis is a systemic illness it can lead to damage involving the brain and peripheral nervous system, skin, lungs, heart, and eyes.
Further, treatment with many of the medicines used in rheumatoid arthritis can lead to side-effects that affect the gastrointestinal system, the lungs, heart, and bones.
The course of RA is variable but progressive if untreated.
Causes of death include infection, malignancies, and vascular disease. There is some evidence that atherosclerosis (hardening of the arteries) is accelerated and that certain cancers such as multiple myeloma and lymphoma occur more often.
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