Which history is most consistent with rheumatoid arthritis?

Rheumatoid arthritis (RA) typically presents with an insidious onset characterized by symmetrical joint swelling. This means that the condition gradually develops over time, rather than appearing suddenly. The symmetrical nature of the joint involvement is a hallmark of RA, often affecting multiple joints simultaneously, which differentiates it from other types of arthritis that may have a different presentation.

In addition to joint swelling, patients often experience symptoms such as joint stiffness, particularly in the morning or after periods of inactivity, but the key feature in this context is the symmetrical pattern of involvement. This contrasts with other forms of arthritis that may start more acutely or affect only one joint at a time.

The other options suggest characteristics that are not typically associated with RA. For example, acute onset and monoarticular joint swelling point towards conditions like gout or septic arthritis, while morning stiffness is a symptom commonly seen in various types of arthritis but is not the defining feature of RA. Thus, the insidious onset with symmetrical joint swelling is the most consistent presentation for rheumatoid arthritis.