I. How does rheumatoid arthritis start? Rheumatoid arthritis can be seen at any age, the onset of the disease generally increases with age, the peak age of onset of 20-40 years old, while women are 40-60 years old, rheumatoid arthritis to women more frequent, female patients are 2-3 times more than male patients. Most patients with rheumatoid arthritis have an insidious onset, the finger joints just wake up in the morning and feel inflexible and tense, sometimes light, sometimes heavy, recurrent, gradually aggravated, often do not attract attention, in this way the disease accounts for about 60-70%, the patient is often difficult to explain the specific date of onset. The duration of the disease also varies. In addition to local joint symptoms, the disease may also be accompanied by general discomfort at the earliest stage, with some patients experiencing fatigue, low fever, loss of appetite, weight loss, skeletal muscle pain and numbness and tingling in the hands and feet. When waking up in the morning, the finger joints feel inflexible and tense, but after getting up and moving around, the joint discomfort will be reduced or disappear, this phenomenon is called “morning stiffness”, morning stiffness is the first symptom of rheumatoid arthritis. As the disease progresses, joint pain, swelling and symmetry may occur. The skin around the joints is warm and flushed, and the pain is caused by automatic or passive movements. It is most commonly seen first in the fingers and toes, with pyknosis in the proximal interphalangeal joints. Subsequently, it can be seen in the palmar-plantar, wrist, elbow, shoulder, ankle, knee, hip and other joints. It is painful, cold, swollen and sore, and is relieved by warmth. The pain increases with cold, and the muscles near the joints become stiff and atrophy. The affected joints become stiff and deformed, and the knees, elbows, fingers and wrists are fixed in the flexed position, and finally immobilized. In a few cases, the onset of the disease is acute, with one or more joints suddenly becoming red, diffusely swollen, with burning pain, pain through the bone, obvious pressure pain, or even pain that is not palpable, and restricted joint movement, or completely immobile. Increased serum mucin, joint x-ray, joint swelling, joint space widening and peri-articular soft tissue swelling. 2. What are the different ways of starting rheumatoid arthritis? Rheumatoid arthritis has different ways of initiation. According to the urgency of the onset of the disease is divided into insidious type (about 50%), subacute type (about 35%-40%), sudden onset type (about 10%-25%) three types. The latter can start with tenosynovitis, bursitis, polymyalgia, and also manifest as systemic vasculitis, pulmonary fibrosis or weakness, wasting and other peripheral symptoms. What are the clinical classifications of rheumatoid arthritis? If the time of onset and the site of onset are combined, the onset of RA is usually divided into the following categories: 1. Gradual onset: The patient can only tell the approximate month of onset. Most of the cases are symmetrical with multiple small peripheral joints, such as the wrist, metacarpophalangeal, proximal interphalangeal, ankle and toe joints. Morning stiffness is more pronounced. 2.Incognito monoarticular onset: The large joints are often involved first, and the lesions are confined to that joint for a period of time, but can eventually spread to multiple joints such as the wrist, fingers, ankle, and toe. 3.Sudden multi-joint involvement: A few patients can suddenly develop pain, diffuse swelling and limited joint movement in multiple joints such as shoulder, elbow, wrist, finger, medulla, knee and ankle. The patient can state the exact date of onset. This type of attack can be seen in patients of any age, but predominantly in the elderly. The typical clinical manifestations of RA appear as the disease progresses. This mode of onset needs to be differentiated from remitting seronegative symmetric synovitis with concussive edema. 4. Acute monoarticular involvement: Knee, elbow and shoulder joints are predominantly involved. Infection, pseudogout and gout have similar manifestations but are more painful, and synovial fluid tests help to differentiate. 5, bursitis and tenosynovitis: can be the first manifestation of RA. Some patients are seen with symptoms of carpal tunnel syndrome. 6.Symptoms of polymyalgia and polyarthralgia start in elderly patients: involving the neck, shoulder, elbow and knee joints, with significant weakness and fever that can last for several months, plus increased blood sedimentation, similar to rheumatic polymyalgia. The disease eventually progresses to typical RA. Generally speaking, as long as early detection and active comprehensive treatment is carried out at an early stage, the prognosis is better and easy to recover. If treatment is not timely and delayed, late stage can lead to disability and poor prognosis. Therefore, if any of the above rheumatoid arthritis symptoms appear, please go to a hospital with rheumatology department for detailed examination in time to make a correct diagnosis for early diagnosis and treatment.