It is more common in middle-aged and elderly people, and the onset process is more slow. Hand, knee, hip and spine joints are easy to be involved, while palms, fingers and wrists are less involved. The disease usually worsens with activity or decreases with rest. The morning stiffness time is generally less than half an hour. When both hands are involved, Hubbard's tubercle and bouchard's tubercle can be seen in physical examination, and the knee joint can feel friction. There were no extraarticular manifestations such as subcutaneous nodules and vasculitis. Most rheumatoid factors are negative, and a few elderly patients may have low titer positive.
2. Psoriatic arthritis
The polyarthritis type of psoriatic arthritis is very similar to rheumatoid arthritis. However, patients with this disease have a characteristic silver rash or nail lesions, or have a family history of psoriasis. The distal interphalangeal joint is often involved, and its early distribution is asymmetric, and antibodies such as rheumatoid factor in serum are negative.
3. Ankylosing spondylitis
This disease is common in young men, mainly involving sacroiliac joints, spinal joints and other axial joints. Although there are peripheral joint diseases, most of them are asymmetric swelling and pain of the major joints of lower limbs, and are often accompanied by pain at the attachment points of tendons and ligaments such as spinous process, greater trochanter, achilles tendon and spinal costal joint. The extraarticular manifestations were iridocyclitis, cardiac conduction block and aortic valve insufficiency. X-ray film shows that sacroiliac joint is invaded, destroyed or fused. The patients were negative for rheumatoid factor, and most of them were positive for HLA-B27 antigen. The disease has obvious familial tendency.
4. Lupus erythematosus
Arthritis of hands or wrists may occur in patients with this disease at the initial stage, but patients are often accompanied by lupus-specific and multi-system manifestations, such as fever, fatigue, oral ulcer, rash, cytopenia, proteinuria or positive antinuclear antibody, while arthritis is lighter than rheumatoid arthritis and has no joint deformity. A variety of autoantibodies can be found in laboratory examination.
5. Reactive arthritis
The onset is acute, and there is often a history of intestinal or urinary tract infection before the onset. Asymmetry mainly involves large joints (especially lower limb joints), and generally involves small joints such as interphalangeal joints and wrist joints near asymmetric fingers. May be accompanied by ophthalmia, urethritis, balanitis and fever. HLA-B27 can be positive and rheumatoid factor negative, and patients may have X-ray changes of asymmetric sacroiliitis.