A nurse is assessing a patient for early manifestations of rheumatoid arthritis (RA). Which of the following changes is an early manifestation of RA?

Choice A rationale Decreased hemoglobin is typically associated with chronic inflammation in rheumatoid arthritis, but it is not considered an early manifestation. Anemia of chronic disease develops over time due to the effects of inflammatory cytokines on iron metabolism and erythropoiesis. Normal hemoglobin ranges for females are 12 to 15.5 g/dL and for males are 13.5 to 17.5 g/dL. Choice B rationale Temporomandibular joint pain can occur in rheumatoid arthritis, but it is not a specific or consistent early manifestation. While RA can affect various joints, the small joints of the hands and feet are more commonly involved in the early stages. Pain in the TMJ can also be related to other conditions. Choice C rationale Fatigue is a common systemic symptom in rheumatoid arthritis and can occur early in the disease process. However, fatigue is also a nonspecific symptom that can be present in many other conditions, making it less definitive as an early diagnostic indicator compared to joint involvement. Choice D rationale Symmetric joint swelling of the fingers, particularly the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, is a hallmark early manifestation of rheumatoid arthritis. The inflammation causes synovial thickening and effusion, leading to palpable swelling that affects the same joints on both sides of the body.