Rheumatoid arthritis is complicated. Most people with rheumatoid arthritis will tell you that some time passed before they were given a definitive diagnosis. Even if their doctor suspected rheumatoid arthritis early on, there is no single test or piece of evidence that confirms the diagnosis. Findings from a patient’s physical examination, medical history, laboratory tests, and imaging studies must all be considered.
Not only are there few disease-specific features associated with rheumatoid arthritis, patients present with various manifestations of the disease. In most rheumatoid arthritis patients, the onset of symptoms occurs gradually and is well-established before even being recognized. The polyarthritis aspect typically involves the small joints of the hands and feet before moving to larger joints. But there are other ways rheumatoid arthritis presents itself which are less common: palindromic (short bouts of recurrent pain and stiffness, affecting one or more joints, later becoming persistent); polymyalgic (often an elderly patient with primary complaint of stiffness, often shoulders or hips); systemic (non-articular manifestations, such as fever, malaise, weight loss); persistent monoarthritis (arthritis in a single large joint that persists).
Early rheumatoid arthritis can differ from what we think of as typical rheumatoid arthritis.