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RA Symptoms

RA varies considerably from individual to individual in terms of severity and the course that it follows. However, it is associated with symptoms that are characteristic of the disease. These include inflammation, with pain, swelling, and stiffness affecting joints throughout the body; symptoms affecting the entire body, including soreness, fever, weight-loss, fatigue, and weakness; and symptoms associated with extra-articular manifestations of the disease, including conditions affecting the lungs, heart, eyes, and other organs and organ systems.


Joint involvement in RA

The most common set of symptoms in RA are inflammation, pain, swelling, and tightness or stiffness affecting the joints. In the early stages of RA, joint involvement may be limited to the hands and feet. However, during the course of the disease joints throughout the body may become affected, including the ankles, knees, hips, elbows, shoulders, and the neck. Joint involvement in RA typically occurs with a characteristic pattern, with symptoms affecting the joints on both sides of the body. For instance, a patient with RA will typically experience joint pain and swelling in both hands, knees, or hips.1

Hand. In RA, joints in the hand will be tender when squeezed or during movement and decreased grip strength may be evident. In some patients, there may be a visible swelling and redness affecting the entire hand. Up to 5% of patients with RA develop carpal tunnel syndrome, a condition involving numbness, weakness, and tingling in the hand.1

Without the proper management, RA can result in deformity of the hands, with tendons on the back of the hand becoming tight and fingers developing exaggerated profiles.1

Learn more about hand pain

Wrist. Among joints in the arm, the wrist is the most commonly affected joint in patients with RA. During early stages of the disease, a patient may find it difficult to bend his or her wrist backward.

Learn more about wrist pain

Elbow. The elbow may be inflamed with swelling causing nerve compression that results in numbness and tingling in the fingers.

Learn more about elbow pain

Shoulder. Pain and inflammation affecting the shoulder resulting in a limitation of movement tends to occur only in the later stages of the disease.

Learn more about shoulder pain

Foot. The feet, similar to the hands, are often affected in the early stages of RA. The top of the foot may become red and swollen. Joints at the base of the toes may become tender, making it painful to walk and causing the patient to shift weight to the heel and bend the toes upward while standing or walking. In some patients, the heel may also become painful.

Learn more about foot pain

Ankle. Joints in the ankle may become inflamed and swollen. This inflammation and swelling may eventually lead to nerve damage, resulting in numbness and tingling in the feet.

Learn more about ankle pain

Knee. Involvement in large joints, including the knee, tends to occur in later stages of RA. The knee may swell, making it difficult to bend and move.

Learn more about knee pain

Hip. Involvement in large joints, such as the hips, tends to occur in later stages of RA. Swelling and inflammation of the hips may make it difficult to walk and support the weight of the body.

Learn more about hip pain

Cervical spine. RA may affect the cervical spine, that part of the spine between the head and shoulders, resulting in pain and stiffness in the neck that affects the ability of the patient to turn the head and bend at the neck.

Learn more neck & cervical pain

Cricoarytenoid joint. The cricoarytenoid joint (also called the larynx joint) is a joint located near the windpipe. About one-third of patients with RA experience inflammation of this joint, resulting in difficulty breathing and hoarseness of the voice.


Joints affected in RA

  • Joint tenderness during movement or when pressure applied (especially affecting joints in middle of fingers and at base of fingers)
  • Stiffness
  • Loss of grip strength
  • Possible redness or inflammation affecting whole hand
  • Increased risk for carpal tunnel syndrome
  • Joint tenderness at base of toes (may cause patient to walk on heel or lift toes upwards)
  • Swelling and redness on top of foot
  • Heel pain
  • Pain, inflammation, and swelling makes it difficult to bend wrist backwards
  • Pain, stiffness, and inflammation, with restriction of movement
  • Pain, inflammation, and swelling
  • Increased pressure on nerves running to foot may lead to numbness and tingling in feet
  • Pain, inflammation, and swelling, with restriction of movement
  • Pain, inflammation, and swelling, with restriction of movement
Cervical spine
  • Inflammation affecting portion of spine between head and shoulder
  • Pain and stiffness affect the neck and restrict head and neck movement
Cricoarytenoid joint
  • Inflammation affecting joint near windpipe may affect breathing and result in vocal hoarseness


General symptoms in RA

In addition to symptoms affecting the joints, several other symptoms are common in patients with RA. Patients may experience a general soreness, aching, and stiffness affecting the entire body. RA is commonly associated with fatigue and weakness, a feeling of sickness or malaise, as well as persistent low-grade fever. Individuals with RA may have difficulty sleeping, suffer from emotional problems, including depression and anxiety, and experience weight loss.1


General symptoms in RA

  • General soreness, aching, and stiffness throughout the body
Fatigue and weakness
  • Lack of energy
  • Muscle weakness and lack of strength
  • Feeling of sickness or malaise
  • Low-grade persistent fever
Difficulty sleeping
  • Ability to sleep comfortably may be affected by other RA symptoms
Psychiatric problems
  • Depression, anxiety, stress
Weight loss
  • Early symptom resulting from immune system chemicals


Rheumatoid nodules and inflammatory and other conditions

RA is associated with a range of extra-articular manifestations or conditions that occur outside of the joints and affect other organs and organ systems. These include formation of RA nodules in various locations throughout the body, blood abnormalities (eg. anemia), and inflammatory conditions affecting the eyes, heart, lungs, blood vessels, and nerves.1


RA nodules

As RA progresses, it may be associated with the formation of nodules or lumps beneath the skin that can occur in a range of different locations throughout the body. The most common locations for RA nodules are pressure points including the underside of elbows and forearms. However, they may form on the back of the head, the Achilles tendon, tendons located in the hand, and at the base of the spine. They may even form inside the lungs.1


Inflammatory conditions

RA is associated with inflammation that affects joints and with inflammatory conditions affecting a range of organs and organ systems, each associated with a distinct set of symptoms.1

Heart. Inflammation affecting the tissue that lines the chest cavity (pericarditis) may lead to pain in the chest, as well as breathing difficulty.

Lungs. Inflammation affecting the lung (pleuritis, pneumonitis) (not associated with lung infection) may cause a chronic cough and shortness of breath.

Nerves. Inflammation affecting the peripheral nerves may cause numbness and tingling in the hands or feet.

Eyes and mouth. RA is associated with secondary Sjögren’s syndrome, which causes dry eyes and dry mouth. Additionally, RA inflammation can lead to episcleritis, a condition affecting the white part of the eye and causing pain, light sensitivity, and tearing. RA can also cause uveitis, scleritis, glaucoma, and cataracts.

Blood vessels. Inflammation affecting the blood vessels (vasculitis) may result in a shortage of blood supply to organs, leading to tissue and organ damage throughout the body.


Extra-articular conditions and symptoms

Organ / condition
RA nodules
  • Hard lumps under skin
  • Most common at pressure points (elbow, forearm), but can occur throughout body (lungs)
  • Pericarditis
  • Associated with pain in chest, breathing difficulty
  • Pleuritis, pneumonitis
  • Associated with chronic cough and shortness of breath
  • Associated with numbness and tingling in feet, hands
Eye and mouth
  • Secondary Sjögren’s syndrome (dryness of eyes, mouth)
  • Episcleritis (light sensitivity, pain, tearing)
  • Ability to sleep may be affected by other RA symptoms
Blood vessels
  • Vasculitis with shortage of blood to organs and tissues
Written by: Jonathan Simmons | Last reviewed: September 2013.
1. Maini RN, Venables PJW. Patient information: Rheumatoid arthritis symptoms and diagnosis (beyond the basics). In: O'Dell JR, Greene JM, eds. UptoDate. Wolters Kluwer Health. Accessed at: 2013.