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While classic rheumatoid arthritis (RA) typically has a gradual onset, sudden or acute onset is possible, especially in older adults. Other conditions, including reactive arthritis and palindromic rheumatism, can also cause sudden joint pain and are often mistaken for RA.

Rheumatoid arthritis (RA)

Although RA usually develops slowly over several weeks to months, an explosive polyarticular onset, with pain and swelling in multiple joints over 24 to 48 hours, is possible.

Acute-onset RA: Some cases, especially in older adults, can appear suddenly and intensely, often affecting larger, more proximal joints like the knees and shoulders.

Widespread symptoms: Along with joint pain and swelling, sudden-onset RA can also cause flu-like symptoms such as fatigue, fever, and a general feeling of being unwell.

Palindromic rheumatism (PR)

This rare form of inflammatory arthritis is characterized by sudden, recurrent attacks of painful swelling in one or more joints.

Rapid onset and resolution: Attacks begin and end quickly, lasting anywhere from a few hours to several days.

Between attacks: Joints appear and feel normal, with no lasting damage.

Progression to RA: While PR is distinct from RA, it's considered an autoimmune-related disease, and up to 50% of people with PR may later develop RA.

Reactive arthritis

This is an autoimmune response that can cause sudden-onset inflammatory arthritis after a bacterial infection.

Triggering infections: Common triggers include gastrointestinal infections (like food poisoning), sexually transmitted infections (STIs), and urinary tract infections (UTIs).

Typical joints: Pain and stiffness most often affect the knees, ankles, feet, and heels.

Additional symptoms: Eye inflammation (conjunctivitis) and urinary problems are also common.

Seronegative spondyloarthropathies

This group of conditions can be difficult to differentiate from RA, particularly if they appear suddenly.

Psoriatic arthritis (PsA): This can cause joint pain and stiffness that mimics RA. Distinctive symptoms that might differentiate PsA include sausage-like swelling of fingers or toes (dactylitis), nail changes, and lower back pain.

Ankylosing spondylitis (AS): Though primarily affecting the spine, AS can also cause pain and stiffness in the pelvis.

Other mimics

Several other conditions can present with sudden, widespread joint pain that may be mistaken for RA:

Viral arthritis: Viruses like parvovirus B19 or Chikungunya can cause acute, multi-joint pain. Symptoms usually resolve once the infection clears.

Lyme disease: This tick-borne illness can cause widespread joint pain and other symptoms similar to RA. Unlike RA, the pain can shift from joint to joint, and it is usually responsive to antibiotics.

Whipple's disease: This rare bacterial infection can cause arthritis that mimics RA, especially in seronegative patients.