In rheumatoid arthritis, which feature is most characteristic?

• A. Asymmetric joint involvement and short stiffness
• B. Monarticular disease
• C. Calcium pyrophosphate deposition
• D. Symmetric joint swelling and prolonged morning stiffness

Answer: (D)

Symmetric swelling of multiple joints with prolonged morning stiffness is most characteristic of rheumatoid arthritis. This pattern reflects inflammatory synovitis that tends to involve many joints on both sides of the body, especially the small joints of the hands and feet, and causes stiffness that lasts for a long time after waking, typically over an hour. This distinguishes RA from other arthritides: osteoarthritis usually shows asymmetric involvement with brief morning stiffness; a single joint presentation points to gout or septic arthritis; calcium pyrophosphate deposition disease is a crystal arthropathy not defining RA.