Summary
Definition
History and exam
Key diagnostic factors
- active symmetric arthritis lasting >6 weeks
- age 50 to 55 years
- female sex
- joint pain
- joint swelling
Other diagnostic factors
- morning stiffness
- swan neck deformity
- Boutonniere deformity
- ulnar deviation
- rheumatoid nodules
- vasculitic lesions
- pleuritic chest pain
- scleritis and/or uveitis
Risk factors
- genetic predisposition
- smoking
Diagnostic investigations
1st investigations to order
- rheumatoid factor (RF)
- anticyclic citrullinated peptide (anti-CCP) antibody
- radiographs
- ultrasonography
Investigations to consider
- disease activity score(s)
Treatment algorithm
mild disease activity at initial presentation: not pregnant or planning pregnancy
moderate-to-severe disease activity at initial presentation: not pregnant or planning pregnancy
pregnant or planning pregnancy
failure to reach low disease activity after 3 months of therapy: not pregnant or planning pregnancy
Contributors
Authors
Yusuf Yazici, MD

Clinical Associate Professor of Medicine
New York University School of Medicine
New York
NY
Disclosures
YY receives research support from BMS and Genentech; he has consulted for Amgen, BMS, and Sanofi.
Peer reviewers
Chris Deighton, BMedSc, MD, FRCP
Consultant Rheumatologist
Department of Rheumatology
Royal Derby Hospital
Derby
UK
Disclosures
CD has received honoraria for talks at symposia sponsored by Wyeth and Abbott.
Raashid Luqmani, DM FRCP, FRCP(E)
Consultant Rheumatologist
Nuffield Orthopaedic Centre
Senior Lecturer in Rheumatology
Botnar Research Centre
University of Oxford
Oxford
UK
Disclosures
RL declares that he has no competing interests.
Alan Bridges, MD
Professor of Medicine
Section of Rheumatology
University of Wisconsin
Madison
WI
Disclosures
AB has received fees for speaking and consulting from Abbott, BMS, UCB, and Genentech.
John Kirwan, BSc, MB, BS, MD
Emeritus Professor of Rheumatic Diseases
School of Clinical Sciences
University of Bristol
Bristol
UK
Disclosures
JK declares that he has no competing interests.
Paul Emery, MA, MD, FMedSci
Professor of Rheumatology
Arthritis Research UK
Director
Leeds Institute of Rheumatic and Musculoskeletal Medicine
University of Leeds
Director
Leeds Musculoskeletal Biomedical Research Unit
Leeds Teaching Hospitals NHS Trust
Leeds
UK
Disclosures
Not disclosed.
Prabha Ranganathan, MD, MS
Associate Professor of Medicine
Division of Rheumatology
Washington University School of Medicine
St Louis
MO
Disclosures
PR declares that she has no competing interests.
Differentials
- Psoriatic arthritis (PsA)
- Infectious arthritis
- Gout
More DifferentialsGuidelines
- EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs
- ESMO management of toxicities from immunotherapy
More GuidelinesPatient leaflets
Rheumatoid arthritis
Rheumatoid arthritis: questions to ask your doctor
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer