Onset of rheumatoid arthritis is?

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There is great inter-patient variation in the course of the disease. Onset is
insidious and the disease usually presents initially with non-specific symptoms
such as fatigue, malaise, diffuse musculoskeletal pain and stiffness. Charac-
teristically, at onset the patient presents with symmetrical small-joint polyarthri-
tis in the hands, wrists and feet. Diagnostic criteria for rheumatoid arthritis
include presence of morning stiffness, presence of arthritis in three or more
joints, symmetrical involvement, rheumatoid nodules, serum rheumatoid factor
and radiographic changes.

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