In addition, patients with early RA often do not present with the classic, symmetrical polyarthritis involving the hands, wrists, feet, and ankles. Initially, RA often begins with just 1 or 2 inflamed joints. Other joints typically become inflamed over time. Early on, RA joint swelling may come and go, and there are few systemic symptoms. Atypical joints, such as the jaw, will be painful, mimicking temporomandibular joint disorder (TMJD). Subcutaneous nodules are rarely seen in early RA. Laboratory testing is of limited diagnostic use in early RA, but the acute phase reactants—either an erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)—should be elevated, indicating a systemic inflammatory disorder. chinese acupuncture and moxibustionA modest anemia and thrombocytosis also reflect the presence of an inflammatory disease. can acupuncture help anxietyRheumatoid serology, either the rheumatoid factor or the anti-citrullinated peptide (anti-CCP) antibody, are present in 70% to 80% of RA patients. However, because of their relatively poor specificity, they do not need to be obtained by the PCP but could wait until rheumatology consultation.

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