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Early Signs & Symptoms

Early recognition of RA and prompt treatment is crucial in order to achieve disease control and prevent damage to joints resulting in disability. Treatments including disease-modifying anti-rheumatic drugs (DMARDs) and newer biologics have been shown to slow and prevent damage to joints and allow many patients with RA to lead full and active lives.

The challenge of early recognition of RA is that the disease may be difficult to distinguish from other types of arthritis involving inflammation. In the majority of patients, RA may begin with changes and signs that are small and seemingly insignificant. It may take weeks or months before the symptoms become serious enough to seek the help of a doctor. The distinctive characteristics of RA, including erosion of joints, formation of nodules, and manifestations of RA that occur outside of the joints (extra-articular), typically affect patients who have had the disease for a long time.1


What are the early signs of RA?

Early symptoms of RA that may precede noticeable joint pain and stiffness include fatigue, numbness and tingling in hands, muscle pain, a slight low-grade fever, and loss of weight. In some cases, the onset of RA may involve inflammation in tissues other than joints, including the lungs (shortness of breath) and heart (chest pain).2


Early symptoms of RA

Weakness that affects ability to carry out ordinary daily activities
Numbness and tingling
Affecting hands and fingers
Low-grade fever
Low-grade fever resulting from inflammation
Weight loss
Unexplained weight loss perhaps due to weakness and fatigue
Joint tenderness during movement or when pressure is applied (especially affecting joint in middle of fingers and at base of fingers)
Possible redness or inflammation affecting the whole hand
Joint tenderness at the base of toes (may cause patient to walk on heel or lift toes upwards)
Swelling and redness on the top of foot
Heel pain
Pain and swelling makes it difficult to bend wrist backwards


Early joint symptoms. The key features of RA that your doctor will look for include pain and swelling in joints affected by the disease. Pain will be evident as tenderness when pressure is applied to a local area or when a joint is moved. Swelling due to a build-up of fluid in the joint cavity and thickening of joint tissue will give the joint what is often described as a “boggy” feel. Additionally, involved joints may feel hot and appear red, both signs of active inflammation.3

RA typically has a distinctive pattern of joint involvement, with the same joints on both sides of the body affected (this symmetrical pattern may not be evident in the early stages of the disease). In the early stages of RA, small joints tend to be affected more than large joints. For instance, the joints located at the base of the fingers and toes and the joints located in the middle of the fingers. However, in some patients RA may begin with pain in a large joint (shoulder or knee) that moves from one joint to another and comes and goes.2

Hands. In many patients, the joints of the hands are the first to be affected by RA. Joints will be tender when they are squeezed or moved and a decrease in grip strength may be evident. In some patients, there may be visible swelling and redness affecting the entire hand.2

Learn more about hands pain

Wrist. Among joints in the arm, the wrist is the most commonly affected in RA. Even during early stages of the disease, a patient may find it difficult to bend his or her wrist backward.2

Learn more about wrist pain

Elbow. In RA, the elbow may be inflamed and swollen, causing nerve compression that results in numbness and tingling in the fingers.2

Learn more about elbow 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 heels and bend the toes upward while standing or walking. In some patients, the heel may also become painful.2

Learn more about foot pain

Written by: Jonathan Simmons | Last reviewed: September 2013.
1. Venables PJW, Maini RN. Diagnosis and differential diagnosis of rheumatoid arthritis. In: O'Dell JR, Romain PR, eds. UptoDate. Wolters Kluwer Health. Accessed at: 2013. 2. 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. 3. Venables PJW, Maini RN. Clinical features of rheumatoid arthritis. In: O'Dell JR, Romain PR, eds. UptoDate. Wolters Kluwer Health. Accessed at: 2013.