Fast Five Quiz: Rheumatoid Arthritis Myths vs Facts

Herbert S. Diamond, MD


October 25, 2021

Patients with RA may report difficulty performing activities of daily living, such as dressing, standing, walking, personal hygiene, or use of their hands. In addition to articular deterioration, constitutional symptoms (eg, fatigue, malaise, morning stiffness, weight loss, low-grade fever) may be present. Muscles may also become tender, but this is rarely due to myositis. Muscle tenderness is not specific for RA. Severe muscle tenderness should suggest another differential diagnosis, including fibromyalgia or a regional pain disorder.

Stiffness in patients with RA is determined by limitation of motion, which may vary with the time of day. However, stiffness that is due to articular surface derangement or soft-tissue contractures around the joint does not vary with the time of day. Morning stiffness in the joints can last as long as several hours and usually lasts longer than 1 hour. Severe stiffness in the hands may improve with heat, but it is most effectively relieved with active exercise.

In most patients, RA has an insidious onset. It may begin with systemic features (eg, fever, malaise, arthralgias, and weakness) before the appearance of overt joint inflammation and swelling. A small percentage of patients have an abrupt onset, with acute development of synovitis and extra-articular manifestations. Spontaneous remission is uncommon, especially after the first 3-6 months.

Read more on the presentation of RA.


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