Rheumatoid arthritis is distinguished by its symmetric, polyarticular involvement, with noted sparing of the distal interphalangeal (DIP) joints. Patients will describe stiffness of the joints occurring after prolonged periods of inactivity (morning stiffness). Multisystem involvement is characteristic, and depression, fatigue, and generalized myalgias are also common. Extraarticular symptoms and signs include pericarditis, myocarditis, pleural effusion, pneumonitis, and mononeuritis multiplex syndrome.
Articular involvement is noted for symmetric, painful, tender joints. A "boggy," slightly edematous synovium may be palpated. Sparing of the DIP joints is the rule, with an additive involvement of affected joints during the course of the illness. Arthrocentesis of synovial fluid is typically noted for an inflammatory profile.
Treatment during an acute exacerbation is directed at reducing pain and inflammation. Salicylates or other NSAIDs are the cornerstone of treatment, with immobilization providing added relief from joint movement pain. Corticosteroids may be utilized for brief periods with long-term therapy using agents such as antimalarials, gold, and methotrexate.
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