Symptoms and signs The disease varies individually in terms of condition and course, ranging from transient, mild oligoarthritis to acute progressive polyarthritis. The most commonly affected joints are the proximal interphalangeal, metacarpophalangeal, wrist, elbow, shoulder, knee, and toe joints; the cervical spine, temporomandibular, sternoclavicular, and acromioclavicular joints may also be involved with limited motion; hip involvement is rare. Arthritis often presents with symmetric, persistent swelling and pressure pain, often accompanied by morning stiffness. The most common joint deformities are ankylosis of the wrist and elbow, subluxation of the metacarpophalangeal joints, ulnar deviation of the fingers, and a “swan neck” or button-like appearance. In severe cases, the joints are fibrous or bony ankylosis, and the muscles around the joints atrophy and spasm, resulting in loss of joint function, making life unmanageable. In addition to joint symptoms, rheumatoid nodules and visceral lesions such as heart, lung, kidney, peripheral nerve and eye may also appear. Most active patients have mild to moderate orthocytic anemia, mostly normal white blood cell count, sometimes eosinophils and platelets are seen, serum immunoglobulin IgG, IgM, IgA may be elevated, serum complement levels are mostly normal or mildly elevated, 60%-80% of patients have high levels of rheumatoid factor (RF), but RF positivity is also seen in Chronic infections (hepatitis, tuberculosis, etc.), other connective tissue diseases, and normal elderly people. Other autoantibodies such as anti-keratin antibodies (AKA), anti-perinuclear factor (APF) and anti-cyclic citrullinated polypeptide (CCP) have a high diagnostic specificity for rheumatoid arthritis, with a sensitivity of about 30-40%. X-rays To clarify the diagnosis, stage and progression of the disease, X-rays of both wrists and hands and/or feet should be taken at the beginning of the disease, as well as X-rays of other affected joints. early X-rays of RA show swelling of the soft tissues around the joints and mild osteoporosis near the joints, followed by joint space narrowing, joint destruction, joint dislocation or fusion. The X-ray changes are classified into stage IV according to the degree of joint destruction.