18th January 2024

Background

When assessing patients in early disease, the ‘typical’ features associated with RA, such as joint erosions and rheumatoid nodules, are not usually present. So, joint manifestations are often difficult to distinguish from other inflammatory polyarthritis.

Septic arthritis should be excluded in any joint that is red, hot, and swollen. This should be done via means of joint aspiration as long as there is no skin infection around the site of aspiration, and there is no metalwork inside the joint (in this case, a Trauma and Orthopaedic opinion should be sought). Septic arthritis needs to be treated with antibiotics as soon as possible.

If there are episodes of joint inflammation sequentially affecting one to several joints for hours to days (with symptom-free periods lasting days to months), consider palindromic rheumatism. Some patients do, however, go on to develop a well-defined rheumatic disease, most commonly RA or SLE. Patients with anti-CCP are more likely to develop RA.