Rheumatoid Arthritis (RA)

Rheumatoid Arthritis

Signs and Symptoms of Rheumatoid Arthritis

Joseph Bennington-Castro
By
Samir Dalvi, MD
by
a person feeling symptoms of rheumatoid arthritis
Rheumatoid arthritis usually begins in the small bones of the hands.Getty Images

Rheumatoid arthritis (RA) develops when the immune system invades and attacks the synovium — the thin tissue lining the protective capsules around the body’s joints (the place where two bones meet).

This autoimmune attack causes joint inflammation, the hallmark of RA. When inflamed, the synovium releases damaging chemicals to nearby areas.

Over time, inflammation can not only damage and deform the joints — and the cartilage and bones within the joints — but it can also affect surrounding muscles, ligaments, and tendons that support the joints.

In some cases, RA can also affect other areas of the body.

How Rheumatoid Arthritis Progresses

RA can develop in many different ways, but there are two general patterns of progression: the more common “classic” disease progression and the less common palindromic rheumatism disease progression.

Classic Rheumatoid Arthritis Disease Progression

The main signs of RA are joint swelling, pain, and stiffness.

Rheumatoid arthritis typically begins in a gradual and subtle way, with symptoms slowly developing over a period of weeks to months and getting worse over time. The disease ultimately causes joint damage in up to 85 percent of patients, mostly within the first two years.

In the early stages of classic RA, many symptoms may not be present, except for morning stiffness. As the disease progresses, the joints will start swelling up and other organ systems (like the lungs and eyes) may also become inflamed. Over time, without adequate and early treatment, joints will become visually deformed — misshapen joints can press on the nerves and cause nerve pain. Finally, the joints become essentially fused.

Rheumatoid arthritis is symmetrical — that is, the condition typically affects joints on both sides of the body. It usually begins in the small bones of the hands, wrists, and feet. Many people also experience RA symptoms in their shoulders, elbows, knees, and ankles.

Most cases of RA are polyarticular, meaning the disease affects five or more joints at once. Some people experience a sudden onset of polyarticular symptoms over 24 to 48 hours.

In some cases, people with RA experience monoarthritis, in which only a single joint — usually a large one, such as the knees or hips — is affected at first. But eventually other joints are affected as the disease progresses, usually within three to five years.


Palindromic Rheumatism Disease Progression

Though most people experience this classic disease progression, others experience palindromic rheumatism.

The palindromic pattern of RA involves symptoms affecting one to several joints over a few hours or days followed by symptom-free periods that may last for months. The symptoms later return in the same or other joints, and over time the pattern repeats more frequently. After an attack, the joints usually return to normal without permanent joint damage.

In both the classic and palindromic patterns, most people develop inflammation of the joints in the arms and legs as the disease progresses. People may eventually develop inflammation of the spine and large central joints, such as the hips.

 About 30 percent of people develop inflammation of a joint near the larynx or windpipe (cricoarytenoid joint), causing hoarseness and difficulty breathing.

What Are Common Symptoms of Rheumatoid Arthritis?

Joint symptoms include:

  • Pain
  • Swelling
  • Stiffness, especially in the morning
  • Redness
  • Warmth

Different joints may experience specific symptoms. For example, the joints of the hands become tender when squeezed and grip strength reduces. Affected wrists may become difficult to bend backward. If there’s swelling in the elbow joints, it can compress nerves and cause numbness or tingling in the fingers; similarly, ankle inflammation can cause numbness and tingling in the foot.

Sometimes, systemic symptoms (those that affect the whole body) precede joint symptoms by weeks to months and may be an early sign of RA.

These symptoms, which may also develop after joint symptoms, include:

  • Fatigue or tiredness
  • Malaise
  • Depression
  • Low-grade fever
  • Decreased appetite and weight loss
  • Sweating

Some people also experience joint deformities from RA. People who have lived with the disease for a long time, especially people who have lived with uncontrolled disease, may develop deformities over time, such as:

  • Swan-neck, in which the joint at the base of the finger and the outermost joint bend in while the middle joint straightens
  • Hitchhiker’s thumb (also known as Z-shaped deformity), in which the joint at the base of the thumb bends in and the joint below the thumbnail bends backward
  • Hammertoe (or claw toe), in which the toes either bend up from the joints at the ball of the foot, down at the middle joints, or down at the top toe joints (curling under the foot)
  • Boutonnière, in which the joint nearest the knuckle bends toward the palm and the outer joint bends away from it, per OrthoInfo

Is Carpal Tunnel Syndrome Pain Related to RA?

About 1 in 5 people with RA develop carpal tunnel syndrome from the disease, in which the nerves controlling the sensation and movement of the hands are compressed.

 This occurs because the swelling of the hands from RA compresses a nerve that runs through the wrist.
Researchers have long believed that carpal tunnel is more common in people with RA than the general population, but a study from 2015 found the incidence of carpal tunnel syndrome to be roughly equal between the two groups.

 However, some experts believe that this finding is due to RA medication, which reduces the swelling and inflammation that could ultimately lead to carpal tunnel syndrome.

Carpal tunnel syndrome can cause aching, numbness, tingling, and weakness of the fingers and part of the hands.

Rheumatoid Arthritis and Morning Stiffness Symptoms

Morning stiffness — considerable joint pain and stiffness that interferes with physical functions after sleep — is a hallmark symptom of RA, though it’s also commonly seen among people with other types of inflammatory arthritis.

It’s unknown what exactly causes RA-related morning stiffness. It may be related to circadian rhythms and natural activation of inflammatory processes at night.

Morning stiffness duration varies among people. In those with inflammatory arthritis — whether from RA, Systemic lupus erythematosus (SLE), or Crohn’s Disease — it can last over an hour. Morning stiffness from noninflammatory arthritis, such as osteoarthritis, typically lasts less than an hour — although there is overlap among these diseases.

What Are Rheumatoid Nodules?

Up to 30 percent of people with RA develop noticeable, painless bumps — called rheumatoid nodules — beneath the skin around joints, according to research.

It is the most frequent skin manifestation of RA and develops when the small blood vessels become inflamed.

The bumps may be pea-sized or as large as lemons. In some cases, the nodules move easily when touched; they may also be stiff and fixed to deeper tissues. They are usually not tender unless the underlying nerves are experiencing inflammation, ulceration, or impingement.

Rheumatoid nodules most often occur on the elbow and underside of the forearm.

 They also commonly develop on other pressure points or areas that experience repetitive irritation, including:

  • Feet and heels
  • Knees
  • Fingers
  • Back of the head
  • Base of the spine
  • Tendons of the hand
  • Achilles tendon

In rare cases, the nodules may form on the visceral organs, including the lungs, heart, and white outer layer of the eyes.

Other skin manifestations include conditions related to blood vessel inflammation, such as leg ulcers, lesions, and hemorrhages.

Severe Rheumatoid Arthritis Symptoms

Less commonly, rheumatoid arthritis affects more than just the joints, especially in more progressive forms of the disease. People with RA may experience various other issues depending on where their inflammation is located.

These symptoms can include:

  • Eye pain and vision problems from inflammation in the eye
  • Dry eyes and dry mouth from Sjogren’s syndrome, an inflammatory condition of the tear and saliva glands that affects 10 to 15 percent of people with RA
  • Pericarditis, or painful breathing and chest pain from inflammation of the tissue lining the chest cavity and surrounding the heart
  • Pleurisy, an inflammation of the lining of the lung causing pain and shortness of breath
  • Tingling, pain, numbness, or burning sensation in hands and feet from an inflammation affecting the nerves
  • Fatigue, muscle pain, kidney problems, rash, weight loss, and other issues from vasculitis (inflammation of the blood vessels)
Rheumatoid arthritis causes anemia (low red blood cell count) in up to half of people with RA. The condition may also affect bone marrow.

 In rare cases, it can also be associated with as leukopenia (low white blood cell count) and an enlarged spleen.

What Are Rheumatoid Arthritis Flares, or Flare-Ups?

The severity of RA symptoms varies. Some days, the joints may feel normal; on other days, RA-related pain and swelling may seem unbearable.

These episodes of increased disease activity are called flares, and they’re an indication that the immune system is attacking the body more than usual.

Flares can be predictable, brought on by specific triggers. Known triggers include physical stress, such as from exercise, surgery, injuries, infections, or medication changes, or from emotional stress, such as from work or family issues.

Other times, flares can spring up out of nowhere without a clear cause. Unlike with stress-related flares, unpredictable flares may not subside on their own and may require medication or a visit to the doctor.

People sometimes have an increase in systemic symptoms from RA flares rather than joint swelling and tenderness.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

  1. Rheumatoid Arthritis. Johns Hopkins Arthritis Center.
  2. The 4 Stages of Rheumatoid Arthritis Progression. CreakyJoints.
  3. Patient Education: Rheumatoid Arthritis Symptoms and Diagnosis (Beyond the Basics). UpToDate.
  4. Case Series: Monoarticular Rheumatoid Arthritis. European Journal of Rheumatology.
  5. Palindromic Rheumatism. Arthritis Foundation.
  6. Rheumatoid Arthritis: Causes, Symptoms, Treatments and More. Arthritis Foundation.
  7. Rheumatoid Arthritis Symptoms. NHS.
  8. Joint Deformities in Rheumatoid Arthritis. Arthritis Foundation.
  9. Boutonnière Deformity. OrthoInfo.
  10. The Incidence of Carpal Tunnel Syndrome in Patients With Rheumatoid Arthritis. International Journal of Rheumatic Diseases.
  11. People With Rheumatoid Arthritis Face the Risk of Carpal Tunnel Syndrome. U.S. News & World Report.
  12. Rheumatoid Arthritis. Johns Hopkins Arthritis Center.
  13. Extra-Articular Manifestations in Rheumatoid Arthritis. Maedica.
  14. Rheumatoid Nodules. American Osteopathic College of Dermatology.
  15. Rheumatoid Arthritis: Symptoms and Causes. Mayo Clinic.
  16. Felty Syndrome. National Organization for Rare Disorders.

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