Inflammatory features

1. The joints in RA are swollen, tender, slightly warm, and stiff. Synovial fluid shows active inflammation: The fluid is cloudy and has an increased number of inflammatory white blood cells.

2. Patients with RA usually have profound and prolonged morning stiffness. Fatigue, anemia of chronic disease, and severe constitutional illness (eg, fever, vasculitis, pericarditis, myocarditis, Felty's syndrome) are common.

C. Joint involvement. RA may begin in one or two joints, but it almost invariably progresses to affect 20 or more. In some cases, joint involvement is nearly symmetric, affecting the same finger joints on each hand. Initially, the disease typically involves the metacarpophalangeal, proximal interphalangeal, wrist, and metatarsophalangeal joints, either alone or in combination with others. It can then affect virtually any other joint.

D. Proliferative/erosive features. The inflamed synovial tissue evolves into a thickened, boggy mass known as a pannus. Pannus can eat through joint cartilage and into adjacent bone, causing radiologically visible erosions.

E. Joint deformity. Deformities of RA are more likely to be the result of damage to the soft tissues and supporting structures of the joint -ligaments, tendons, and joint capsule.

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