Rheumatoid Arthritis: Clinical Manifestations and Diagnosis

Abstract

The onset and course of rheumatoid arthritis (RA) can be highly variable, and the lack of a specific biologic marker can make diagnosis difficult in early disease. A careful history and physical examination and the integration of clinical and laboratory data are often required. The presence of anti-citrullinated peptide antibodies (ACPAs) is one of the best predictors of progression to establish RA. This review describes the clinical manifestations used to diagnose RA, such as physical examination of the hands and wrists, elbows and shoulders, hips, knees, ankles and feet, and cervical spine. Extra-articular manifestations related to rheumatoid nodules, eyes, lungs, heart, blood and blood vessels, and neuromuscular involvement are reviewed. Laboratory tests and differential diagnosis are also discussed. Figures show synovitis in the hand and wrist, rheumatoid nodules near the extensor surface of the elbow, a pelvic radiograph of a patient with classic seropositive RA, erosions in the metatarsal heads and phalanges of the foot of a patient with classic seropositive RA, the anterior edge of the odontoid process, and a typical rheumatoid nodule. This review contains 6 highly rendered figures and 20 references.