• Thrombocytosis

• Eosinophilia

• Large granular lymphocytes (especially in Felty syndrome)

• Elevated erythrocyte sedimentation rate

• Elevated C-reactive protein

• Decreased serum albumin

• Raised serum globulins

• Increased levels of alkaline phosphatase, aspartateaminotransferase, and g-glutamyl transferase

• Rheumatoid factor (occurs in 75-80 percent)

loss of function, and, less commonly, erythema. Synovial fluid may accumulate, causing an effusion. Joint pain is usually more prominent and more persistent than in osteoarthritis, occurring at rest, at night, and on activity. Early morning stiffness is also a key feature suggestive of inflammatory joint disease and one of the diagnostic criteria of RA.

In addition to the symmetrical peripheral joint involvement, the cervical spine may also be involved. The synovium-lined atlantoaxial joint and/or the posterior apophyseal joints may become inflamed, causing pain in the neck and occipital headache. Pain may also occur as a result of temporomandibular joint disease.

Uncontrolled disease eventually results in inflammation spreading beyond the synovium of the joint to other nearby structures, including the tenosynovium of tendons, ligaments, other soft-tissue structures, and bone. Subcutaneous nodules can occur in more severe and advanced subsets of RA, which can cause pain, ulceration, and interference with functional activities. Extra-articular features are common and may involve multiple organ systems.12

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