The first sign is usually stiffening of joints upon awakening which can last a few minutes to an hour or more. Fibrositis, poorly localized pain in which people complain of aching and stiffness in general terms instead of naming specific joints, is the one of the earliest complaints. These symptoms may be present for some time before they are replaced by more specific, or localized, problems. There is usually gradual swelling, warmth, and tenderness at the joint. Changes in appearance of hands can occur such as swan-neck deformities of the fingers, spindle shaped swelling of the fingers, or ulnar deviation of the hands.
All joints can become involved such as the hips, knees, wrists, elbows, shoulders, and the jaw.
Anemia associated with low serum iron level or low-binding capacity is common. Rheumatoid nodules are lesions that develop around small blood vessels which may be tender or nontender, movable or immovable. The size is variable and are typically found over pressure points such as the extensor surfaces of the ulna. The nodules may remain unless surgically removed, or they may resolve spontaneously. The treatment goals are to reduce pain, minimize stiffness and swelling, maintain mobility, and become an informed health care consumer.