Rheumatoid arthritis is a highly inflammatory polyarthritis often leading to joint destruction, deformity and loss of function. Additive, symmetric swelling of peripheral joints is the hallmark of the disease. Extra-articular features and systemic symptoms can commonly occur and may antedate the onset of joint symptoms. Chronic pain, disability and excess mortality are unfortunate sequelae. Epidemiology Rheumatoid arthritis has a worldwide distribution with an estimated prevalence of 1 to 2%. Prevalence increases with arthritis history arthritis history age, approaching 5% in women over age 55. The average annual incidence in the United States is about 70 per 100,000 annually. Both incidence and prevalence of rheumatoid arthritis are two to three times greater in women than in men. Although rheumatoid arthritis may present at any age, patients most commonly are first affected in the third to sixth decades. (top of page) History The typical case of rheumatoid arthritis begins insidiously, with arthritis knee arthritis history the slow development of signs and symptoms over weeks to months. Often the patient first notices stiffness (see below) in one or more joints, usually accompanied by pain on movement and by tenderness in the joint. The number of joints involved is highly variable, but almost always the process is eventually polyarticular, involving five or more joints. Rheumatoid arthritis is an additive polyarthritis, with the sequential addition of involved joints, in contrast to the migratory or expansion joints arthritis history evanescent arthritis of systemic lupus erythematosus or the episodic arthritis of gout. Occasionally, patients experience an explosive polyarticular onset occurring over 24 to 48 hours. (see ACR Guidelines) The joints involved most often are the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the hands, the wrists (particularly at the ulnar-styloid articulation), shoulders, elbows, knees, ankles, and metatarsophalangeal (MTP) joints. The distal interphalangeal (DIP) joints are generally spared. The spine except the atlanto-axial articulation in late arthritis history arthritis history disease is never
