Symptoms of Rheumatoid Arthritis

Rheumatoid arthritis (RA) symptoms can vary from person to person and can even change from day to day.

In people with RA, the body’s immune system attacks the healthy tissues inside the joints. This causes an inflammatory response that results in swelling, stiffness, and pain, especially when the joint is used.^1,2

Symptoms throughout disease progression

In the early stages of the disease, joint tenderness and mild stiffness are common. As the disease progresses, pain, severe stiffness, and swelling also become common. Over time, ligaments, joints, and cartilage become more damaged, leading to deformities, unstable joints, and decreased range of motion.^1,2

The exact cause of RA is not known. Researchers believe that some people have genes that can make them more likely to have RA. However, people with these genes do not automatically develop RA. There is usually something that triggers the condition, possibly like an infection. This causes the immune system to start attacking the joints.^1,2

Signs and symptoms of RA

Knowing the possible signs and symptoms of RA can lead to earlier diagnosis and treatment. This can help prevent or slow joint damage and other complications, and lead to better health.

The most common signs and symptoms of RA include:^2-4

• Swelling, pain, and stiffness in more than 1 joint, even when the joints are not being used
• Joints that are warm and tender to the touch
• Deformities of the joints, especially in the hands and feet
• Soreness throughout the body
• Persistent, low-grade fever
• Weight loss and loss of appetite
• Fatigue
• Weakness, often due to low red cell counts (anemia)

Joint stiffness is usually worse after resting the joint, especially in the morning. However, RA symptoms can come and go. When you experience a great deal of inflammation, pain, swelling, or other symptoms, this is called a flare. Flares can be unpredictable, lasting for days or even months.^5,6

Other manifestations of RA

While joint issues are the most common symptoms of RA, several other health problems are common in people with RA. This can be related to inflammation in the body, chronic pain, side effects of the drugs often used to treat RA, or a combination of factors. These symptoms and conditions include:^5,7,8

• Bone loss and muscle weakness – RA may decrease bone density and weaken muscles around the joints.
• Skin problems – Small lumps, known as rheumatoid nodules, may appear beneath the skin. They are most common on the elbow but may occur on other pressure points on the back of the head, base of the spine, and tendons of the hands.
• Vision problems – Inflammation in the eyes can cause redness, pain, and vision issues. Some people also experience Sjögren’s syndrome, a condition that causes dry eyes and dry mouth.
• Lung disease – Inflammation affecting the lungs may cause a chronic cough and shortness of breath.
• Pericarditis – This is the term used for inflammation of the tissue around the heart. It can cause chest pain and breathing difficulties.
• Vasculitis – This term describes inflammation of the blood vessels. It can cause a shortage of blood supply to the organs leading to tissue and organ damage throughout the body.
• Nerve issues – Some people with RA develop complications that affect both the central and peripheral nervous system.
• Sleep problems – RA pain, soreness, and stiffness often make it difficult to sleep comfortably. Some drugs used to treat RA symptoms may contribute to sleep issues.
• Mental health issues – Many people with RA also experience depression and anxiety, which have been tied to factors like increased pain, fatigue, disability, and reduced quality of life.

Joints commonly affected by RA

In the early stages of RA, the hands and feet may be the only joints affected. However, during the course of the disease, other joints throughout the body may become affected, including the shoulders, elbows, and knees.⁵

RA is symmetrical, which means it usually affects the same joints on both sides of the body. For instance, a person with RA will typically experience joint pain and swelling in both hands, knees, or shoulders.⁵

RA most commonly affects joints in the:^1,5,9,10

• Hands – The hands are usually the first joints affected by RA, and they may feel tender when squeezed or while moving. Weakened hand grip, redness, and swelling are also common. If left untreated, RA can cause hand and finger deformities.
• Feet – Like the hands, the feet are often affected in the early stages of RA. The tops of the feet often become red and swollen. The heels and joints at the base of the toes also become tender, making it painful to walk.
• Wrists – Like the hands and feet, the wrist is one of the earlier and more commonly affected joints. Inflammation of the wrist can make it difficult to bend the wrists, and they may be painful and stiff.
• Shoulders – The shoulders are usually affected in the later stages of RA. Pain and inflammation can limit the range of motion and make it hard to do everyday activities.
• Ankles – RA pain and inflammation in the ankles can make it hard to walk up ramps and climb stairs. As RA progresses, things like walking and standing may even become difficult. RA can also cause the joints in your ankle to become inflamed and swollen. This can lead to nerve damage that causes numbness and tingling in the feet.
• Knees – RA usually affects the knees in the later stages of the disease. It causes the membrane that covers the knee joint to swell, causing pain and stiffness that makes it hard to bend the knees.

Other joints affected by RA

In some people, RA also affects the hip, cervical spine (neck), and cricoarytenoid (larynx) joints of the throat. Involvement of the hip joints tends to occur in the later stages of RA, making it hard to walk and support the weight of the body.

Inflammation of the cervical spine can cause pain and stiffness that makes it hard to bend the neck or turn the head. About 30 percent of people with RA have inflammation of the cricoarytenoid joint. This can cause hoarseness and difficulty breathing.⁵