In most cases, the rheumatoid arthritis develops slowly but progressively. It can start from unknown cause or may be caused by stress. Only in exceptional cases, the disease begins with acute, sudden attacks, which is presented by severe inflammation of one or more joints.
A patient in the beginning stages of the disease may feel unwell, exhausted, and lacking energy in general. Sweating can occur, as well as a weakened appetite and disruption in sleeping patterns. These general symptoms may lead your doctor to the diagnosis of rheumatoid arthritis, – but not necessarily, because many diseases can have a similar clinical picture.
After the initial nonspecific phase, there are early characteristic signs of the disease occurring. One such sign is morning stiffness of the joints, which the patient will most commonly experience in the knuckles first. When they manage to stretch the joints, the patient generally feels no greater problem until the next morning when the stiffness in the joints reoccurs. As time progresses, the morning rigidity becomes more intense and longer lasting.
Shortly after the morning rigidity, the pain that was initially present only occasionally or within some movements of the joint, will be felt on a chronic basis.
The strongest effect of the disease is on the locomotive system, which is primarily related to joints. With time, joints become swollen. Initially, the swelling is not hard and can be pressed in, because it is an inflammatory outburst within a joint pouch.
Rheumatoid arthritis generally initially affects the smaller joints and can spread to larger joints, knees, elbows and shoulders. Additionally, changes may occur in other organs and organ systems.
Specificity of rheumatoid arthritis in relation to some other similar diseases in which joints are affected include symmetrical swellings, usually first on the knuckles of the hands and feet. Also, the metacarpophalangeal joints of hand are affected (metacarpophalangeal joints) as well as joints of fingers (proximal interphalangeal joints).
Chronic inflammation of the small joints of the hand may eventually result in deformation of the hands. This may occur in terms of a turning the fingers to the ulnar side, while the whole hand may be deflected radially, due to degeneration of the wrist.
Subcutaneous nodules may occur, especially in patients with severe clinical picture. Also, the skin may show signs of vasculitis or some other skin diseases. Of the internal organs have been observed to undergo change as a result of rheumatoid arthritis include the heart (pericarditis) and lungs (pleuritis or diffuse interstitial pulmonary fibrosis). Within the eye inflammation of the sclera may occur. The nervous system, lymph nodes and spleen can also be affected.
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