• Mild fever, muscle aches and pains, loss of appetite, and weight loss may precede the main symptoms.

• Pain and stiffness—mainly in the small joints of the hands and feet, but also in the wrists, neck, ankles, and knees—that may start suddenly and are worse in the morning and for rest.

• Possible exacerbation of symptoms during menstruation.

• Possible rheumatoid nodules beneath the skin.

• Possible association with Raynaud's disease or anemia.

• Possible deformation of joints, fluid-filled swelling around joints, and inflammation of the tendon sheaths.

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