Early rheumatoid arthritis. Approach to diagnosis and treatment

Early rheumatoid arthritis is a diagnosis most often made by history and physical examination and is frequently a diagnosis of exclusion. Differential diagnosis can be difficult because of the wide variation in age, sex, constitutional symptoms, physical findings, and joint distribution. Early, aggressive therapy should include patient education, rest, graded exercise, counseling, and appropriate medication. Absence of subcutaneous nodules and joint erosion may indicate a better prognosis in rheumatoid arthritis. Presence of rheumatoid factor, eosinophilia, thrombocytosis, and/or vasculitis suggests a less favorable course.