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1. Causes symmetric & polyarticular arthritis with specific involvement of the hands.

2. Signs and symptoms of RA include > 1 hour of morning stiffness/pain that improves with activity, fatigue, low-grade fever, anorexia, and weight loss.

3. Non-inflammatory joint diseases, such as OA, cause < 30 minutes of stiffness, and pain is worse with activity.

4. Symptoms of RA may be intermittent (15-30%) or progressive. Intermittent disease has remissions lasting up to 1 year and is considered a variant of RA known as palindromic rheumatism.

5. General inspection - patients appear Cushingoid due to chornic steroid use.

6. Associated: carpal tunnel/tarsal tunnel syndrome, atlanto-axial instability, T-L-S spine and S joints are always spared.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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