Rheumatoid arthritis is a chronic disease involving multiple systems in our body which is unknown in origin. It has a diverse systemic manifestation, but the distinguishing feature of Rheumatoid arthritis is chronic inflammatory synovitis, generally incorporating the peripheral joints in a general distribution.

The distinguishing feature of the disease is impending inflammation of the synovium leading to injury of the cartilage and subsequent erosion of the bone and the late changes in the joint integrity. The exact cause of RA is yet to be distinguished, but the following reasons have been implicated to the causative factors of Rheumatoid arthritis.

The significance of some genetic factors specifically the Histocompatibility antigens (HLA- DR 4, HLA- DR 1), the infective possibility (infection and the consequences caused by Epstein- Barr virus, CMV, Parvovirus, Rubella virus and Proteus mirabilis), the environmental causes (detrimental role of urbanization and changes in the climate) are being put forward. However, the hallmark of the rheumatoid disease remains the intense pain in the joints.

Onset of early signs and symptoms usually represents as 'undifferentiated arthritis'. These symptoms do not give adequate evidence to the conclusion of a specific diagnosis for a doctor.

So, there is a problem to treat the disease whether conservatively or aggressively. It is seen that about 40-50% of the patients suffering from 'undifferentiated arthritis' spontaneously become cured while only 30% of the cases subsequently develop Rheumatoid arthritis. The rest of the cases become patients of other types of rheumatic diseases. Early diagnosis and proper goal oriented treatment of RA can reduce damage of the joints, thus check disability.

Characteristically, it is manifested by chronic inflammation of multiple joints. More than two third of patients, it begins gradually with the first probable symptom become fatigue, generalized weakness, loss of appetite along with vague musculoskeletal pain until there is manifestations of synovitis become noticeable.

This prodomal phase can continue for weeks or months and resist the proper diagnosis. Specific sign and symptoms usually become visible gradually as multiple joints particularly those of the knees, feet, hands and wrists get affected in a symmetric fashion.

In the case of mere 10% patients, the onset is more acute, where a quick development of polyarthritis, often associated with systemic symptoms including fever (> 100Ú F), lymphadenopathy (more of the hands and neck) and splenomegaly (enlargement of the spleen).

In about one third of the patients, the early symptoms of Rheumatoid arthritis may be confined to one or a couple of joints. Though the pattern of involvement of the joint may remain asymmetric in some patients, the symmetric pattern remains more typical.

Pain and swelling may be poorly confined to the joint area initially. Pain in the affected joints which is aggravated by movement is the most common sign of established case of this. It matches to the pattern of involvement of joint, but does not constantly show a relationship with the severity of apparent inflammation.

Other early symptoms of Rheumatoid arthritis are morning stiffness that lasts more than an hour, fatigue and noticeable loss of vigor, some symptoms of systemic infective diseases are seen.