The disease usually begins gradually and gradually. General symptoms appear first: malaise, weight loss, poor appetite, headache, insomnia, irritability, sweating, unspecified pain in the joints and muscles.
These symptoms are often called prodromal, but they occur not only at the onset of the disease, but throughout its course.
Vascular and vasomotor disorders are also common symptoms of the disease: cooling of the distal parts of the limbs, wet and cold palms, parasthesia, cyanosis.
According to the literature, men over the age of 15 are equally susceptible to the incidence of RA at all ages. Among women, the highest incidence occurs between the ages of 40 to 55 years and decreases to 60 years and older. There is a clear relationship between menopause and the onset of the disease.
Among the preceding factors, cooling, infections (including the upper respiratory tract; flu, etc.), nervous and physical stress, mental trauma, etc. are important. Angina is preceded by RA only in 15-20% of cases.
However, most often the disease begins for no apparent reason.
Acute onset of the disease is observed in about 25% of cases and more often it happens in persons younger than 40 years.
As a rule, the disease begins imperceptibly, while patients can not specify the date of the onset of the disease and the doctor is not immediately treated. When pain in the joints increases, patients usually first go to the surgeon and the initial diagnosis is due to not
Certainly, the clinical picture is erroneous: “flat bone”, “sprain”, “salt deposition”, etc.
Small or large joints are initially involved equally often, in 40% of cases, one or the other. In the remaining 20%, simultaneous involvement of both large and small joints is observed.
In 1/6 of patients, one joint is primarily involved (most often the knee). The monoarticular stage can last for a long time, making diagnosis difficult. In 30% of cases of defeat sust
Islands at the beginning is one-sided. Thus, in the diagnosis of RA does not have significant
beginning of the disease with the defeat of one or more joints, as well as large or small, symmetrical or asymmetrical.
Approximately in the fourth part of patients intermittent course of the disease is observed. For the rest, it is steadily progressive. The intermeable course is observed more often at a young age, with an acute onset of the disease and with the defeat of larger joints. Patients with a progressive course of RA develop joint deformities in the next 2–3 years.
It should be noted some clinical and pathogenetic features of RA, which presently represent a certain obscurity.
Objectively, there is swelling of the joints, local heat, a violation of their configuration, later – deformities, dislocations, contractures and ankylosis, restriction or loss of function. With a significant effusion in the knee joint, it is possible to note the symptom of the patella bullosing.
In the area of the joints invariably appears atrophy of the skin and muscles. The skin becomes thinner and loses its elasticity. In the joints; sometimes subcutaneous rheumatoid nodes can be noted, and along the neurovascular bundle, an increase in regional lymph nodes.