One to several joints are usually affected. The metacarpophalangeal joints, wrists, elbows, and shoulders are rarely affected without previous trauma. Pain is typically insidious in onset and gradually progresses, usually for many years. Flare-ups may be followed by partial or complete remission. Pain is commonly present when the joint is in motion and is relieved by rest, at least until the advanced stages of disease are reached.
Joints often stiffen for short durations after periods of rest.
Stiffness tends to abate after a few seconds or minutes of joint motion, in contrast to the morning stiffness associated with rheumatoid arthritis, which may persist for several hours. Although the disease can progress rapidly, the course is usually slowly progressive, with gradually increasing dysfunction over many years. It is therefore difficult to determine the prognosis. Examination of the involved joints may reveal mild tenderness, pain, and crepitus on motion. In both cases, the enlargement usually progresses slowly.