Which statement best describes the pattern of joint involvement in rheumatoid arthritis?

• A. Asymmetric arthritis
• B. Monoarticular involvement
• C. Random, unrelated joint involvement
• D. Symmetric arthritis

Answer: (D)

Rheumatoid arthritis characteristically causes symmetric joint involvement. This autoimmune inflammatory process tends to affect the same joints on both sides of the body, most often the small joints of the hands and feet (such as the metacarpophalangeal and proximal interphalangeal joints), as well as wrists and sometimes knees. The symmetry comes from a systemic attack on the synovium that manifests in multiple joints in a mirrored pattern, rather than a random or single-joint process. You’ll often see swelling, warmth, and prolonged morning stiffness in these joints, and the distribution helps distinguish it from other patterns of arthritis. For example, monoarticular or asymmetrical patterns are more typical of gout or septic arthritis, while osteoarthritis tends to be asymmetric and often affects weight-bearing joints with a different distribution. In RA, the symmetrical involvement of small joints is the classic description.