Initial manifestations include Monoarthritis of knee, wrist, shoulder, or ankle Polymyalgia rheumatica-like presentation predominantly with shoulder and hip girdle involvement, especially in older patients Palindromic rheumatism, characterized by recurrent attacks of joint and tendon sheath pain with swelling Joint swelling without chronic joint damage Robustus rheumatoid arthritis with proliferative synovitis but minimal pain Lower spine involvement is not characteristic of rheumatoid arthritis, but cervical spine inflammation can result in instability, which can become an emergency.