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 Baker's cysts are fluid-filled sacs that develop behind the knee and are a later complication of rheumatoid arthritis due to chronic inflammation and joint damage, not an early manifestation. Choice B rationale Fatigue is a common and often debilitating early symptom of rheumatoid arthritis. It is thought to be related to the inflammatory process and the body's immune response, often preceding joint pain and stiffness. Choice C rationale Temporomandibular joint (TMJ) pain can occur in rheumatoid arthritis, but it is not typically considered one of the earliest or most characteristic manifestations. Small joints of the hands and feet are more commonly affected initially. Choice D rationale Decreased hemoglobin, leading to anemia, can occur in chronic inflammatory conditions like rheumatoid arthritis, but it is usually a later finding related to chronic inflammation affecting red blood cell production or increased destruction, not an early manifestation. Normal hemoglobin ranges for women are 12-16 g/dL and for men are 14-18 g/dL.