Rheumatoid arthritis typically presents with which pattern of joint involvement?

• A. Bilateral symmetrical pain in small joints of the hands, wrists, and feet
• B. Unilateral involvement of the knees
• C. Pain limited to the spine
• D. Plantar fasciitis-like discomfort

Answer: (A)

Rheumatoid arthritis is driven by autoimmune inflammation of the synovium, which most often targets small joints in a symmetric, bilateral pattern. This means both sides of the body are typically affected, with joints like the metacarpophalangeal and proximal interphalangeal joints of the hands and the wrists swelling and becoming stiff, especially in the morning for an extended period. That bilateral, small-joint polyarthritis is the hallmark that helps distinguish RA from other joint pains that tend to be unilateral or involve different joints, such as a single knee involved in osteoarthritis, spine-limited pain, or plantar fascia discomfort. The symmetric involvement and the characteristic joint sites reflect the systemic inflammatory process of RA.