Clinical manifestations of rheumatoid arthritis

  Rheumatoid arthritis (RA), a chronic heterogeneous systemic disease of unknown etiology, is characterized by chronic, symmetric, multisynovial arthritis and extra-articular lesions as the main clinical manifestations, and is an autoimmune inflammatory disease.  In China, the prevalence of RA is about 0.32%-0.34%. The disease can develop at any age, but most often occurs between the ages of 30 and 60, and is most common around the age of 45. There are significantly more patients over the age of 60 than those under 30. There are more women than men, with a male to female ratio of 1:2-4. Rheumatoid arthritis can involve any movable joint in the body, with the joints of the extremities, especially the small joints of the hands and feet, being symmetrical, manifesting as swollen and painful joints and can be accompanied by morning stiffness, most often involving the proximal interphalangeal joints, metacarpophalangeal joints, wrists and metatarsophalangeal joints, followed by elbows, knees, shoulders, ankles, sternoclavicular joints, hips, and atlantoaxial joints. The atlantoaxial joint may also be involved. In addition, the temporomandibular joint and other cervical vertebrae may occasionally be involved. When temporomandibular arthritis is present, it can be characterized by pain during chewing and, in severe cases, localized swelling, tenderness and difficulty in opening the mouth. In the early stages, there is joint swelling and pain and dysfunction. In the late stages, the joints may develop varying degrees of stiffness and deformity with atrophy of the bone and skeletal muscles, which can be extremely disabling.  The systemic manifestations of rheumatoid arthritis include, in addition to joint lesions, anemia, granulocytopenia, fever, fatigue, pulmonary fibrosis, pericarditis, cardiomyopathy, subcutaneous rheumatoid nodules, pleurisy, arteritis, splenomegaly, renal amyloidosis, peripheral neuropathy, scleroiditis, and iritis.  Since RA is a curable disease, although there is no cure, early diagnosis and early treatment can control the development of the disease, reduce the occurrence of joint deformities and improve the quality of life.