Which joint pattern is most characteristic of rheumatoid arthritis in its early stages?

• A. Large weight-bearing joints
• B. Spinal involvement first
• C. Distal interphalangeal joints involvement
• D. Small joints of the hands (MCP, PIP) are commonly involved in RA

Answer: (D)

In early rheumatoid arthritis, the hallmark pattern is symmetric inflammatory arthritis of the small joints of the hands, especially the metacarpophalangeal and proximal interphalangeal joints. These joints commonly become tender, swollen, and stiff, with morning stiffness lasting more than an hour. This small-joint involvement contrasts with other patterns: large weight-bearing joints are more typical of osteoarthritis or later RA involvement, spinal involvement is not the usual first clue, and the distal interphalangeal joints are typically spared in RA (they’re more often affected in conditions like osteoarthritis). So the MCP and PIP joints being involved early best fits the RA pattern.