(2 )pain and tenderness: painful on rest location small(PIP, MCP), symmetric joints (3)swelling: synovial proliferation, effusion, swelling of soft tissue (4)articular deformity ulnar deviation of the fingers, swan-neck"deformity, atrophy of skin and muscle wrist (5) osteoporosis(骨质疏松) 腕关节 metacarpophalangeal joint 掌指关节 指间关节 proximal interphalangeal joint
（2）pain and tenderness： painful on rest location：small (PIP,MCP), symmetric joints （3）swelling：synovial proliferation, effusion, swelling of soft tissue （4）articular deformity：ulnar deviation of the fingers, “swan-neck” deformity, atrophy of skin and muscle （5）osteoporosis (骨质疏松) wrist metacarpophalangeal joint proximal interphalangeal joint
fusiformis swelling subluxation of wrist ulnar deviation boutonniere deformity
ulnar deviation boutonniere deformity fusiformis swelling subluxation of wrist
In conclusion a Although the course of Ra in different patient can be quite variable the typical picture of bilateral symmetric inflammatory polyarthritis involving small joints in both the upper and lower extremities with sparing of the axial skeleton except the cervical spine suggests the diagnosiS
In conclusion Although the course of RA in different patient can be quite variable，the typical picture of bilateral symmetric inflammatory polyarthritis involving small joints in both the upper and lower extremities with sparing of the axial skeleton except the cervical spine suggests the diagnosis
Extra-articular manifestations (1)Rheumatoid nodules 口20%-30% patients D on periarticular structures, extensor surfaces, or other areas such as the pleura and meninges The advent indicates that the disease is in the active phase (2)rheumatoid vasculitis: episcleritis, scleritis peripheral neuropathy, multiplex, cutaneous ulceration and dermal necrosis
Extra-articular manifestations （1）Rheumatoid nodules 20%-30% patients on periarticular structures, extensor surfaces, or other areas such as the pleura and meninges. The advent indicates that the disease is in the active phase （2）rheumatoid vasculitis: episcleritis, scleritis, peripheral neuropathy， multiplex, cutaneous ulceration and dermal necrosis