Question

Which of the following is a feature of rheumatoid arthritis?

• A. Heberden’s nodes
• B. Morning stiffness
• C. Asymmetrical joint involvement
• D. Bone spurs

Hint:

RA: Symmetrical, autoimmune, long morning stiffness — OA: Asymmetrical, short stiffness, bone spurs.

Answer 1

The Correct Option is B

Step 1: Understanding rheumatoid arthritis (RA)
Rheumatoid arthritis is a chronic, autoimmune inflammatory disorder that primarily affects synovial joints. The immune system mistakenly attacks the synovial membrane, leading to persistent inflammation, joint damage, and deformity.

Step 2: Morning stiffness as a hallmark feature
One of the classic features of RA is prolonged morning stiffness lasting more than 30 minutes, often exceeding one hour. This stiffness improves gradually with movement and activity during the day, distinguishing RA from osteoarthritis, where stiffness is typically brief.

Step 3: Why morning stiffness occurs
In RA, inflammation in the synovial lining leads to swelling and thickening, producing excess synovial fluid and inflammatory mediators. During periods of rest, such as overnight, this inflammation causes joints to become stiff and painful upon waking.

Step 4: Why other options are incorrect

• Heberden’s nodes: Bony swellings at the distal interphalangeal joints, typical of osteoarthritis, not RA.
• Asymmetrical joint involvement: Common in psoriatic arthritis or reactive arthritis; RA typically has symmetrical joint involvement.
• Bone spurs: Osteophyte formation is a feature of osteoarthritis, not RA.

Step 5: Clinical importance
Early recognition of morning stiffness and other RA symptoms allows for prompt initiation of disease-modifying antirheumatic drugs (DMARDs) to prevent irreversible joint damage.

Morning stiffness > 30 minutes = Key clinical feature of rheumatoid arthritis