Joint Swelling, Tightness or Stiffness

Joint pain, swelling, tightness, and stiffness are the most common symptoms of rheumatoid arthritis (RA). Joints in the hands, wrists, feet, and knees are usually affected first. Over time, RA may affect other joints, including the shoulders, hips, and elbows.1,2

In some cases, RA affects many joints at the same time on both sides of the body. Joint stiffness is usually worse after resting the joint, especially in the morning.1,2

RA symptoms can come and go. When you experience a lot of inflammation, pain, swelling, or other symptoms, this is called a flare. Flares can be unpredictable, lasting for days or even months.1,2

Common areas of RA joint pain

RA usually affects multiple joints throughout the body, including:1-3

  • Ankles
  • Elbows
  • Feet
  • Hands
  • Knees
  • Shoulders
  • Wrists

Understanding the signs and symptoms RA joint pain

RA symptoms often include pain, swelling, tightness, or stiffness in different joints. If you have RA, 1 or more of your joints may be affected.

Ankle

Trouble walking up ramps and climbing stairs are usually the first signs of RA ankle problems. As the condition gets worse, simple walking and standing often become painful. 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.3,4

Elbow

The elbows are often among the first areas affected by RA. This can cause swelling, inflammation, stiffness, pain, and small lumps known as rheumatoid nodules. Swelling in the elbow joints can put pressure on nerves, which causes tingling and numbness in your arms, hands, and fingers. In severe cases, it can cause the elbows to dislocate.5

Foot

Similar to the hands, the feet are often affected in the early stages of RA. The top of your feet may become red and swollen. The joints at the base of your toes may become tender, which can make it painful for you to walk.3,4

Hand

Joints in the hands are usually the first to be affected by RA. These joints may feel tender when your hand is squeezed or when you move them. It is also common for your hand’s grip to weaken. Some people with RA experience redness and swelling on their entire hand. If left untreated, RA can cause your hands to become bent or twisted.2,3

Knee

Knee pain usually occurs in the later stages of RA. The condition causes the membrane that covers the knee joint to swell, which causes pain and stiffness. This can make it hard to bend your knees. RA can also cause a Baker’s cyst (a fluid-filled sac) to form in the hollow space at the back of the knee.3,6

Shoulder

Shoulder pain and inflammation tend to happen in the later stages of RA. This can limit your range of motion and make it hard to do things like reaching up to a shelf or lifting your arms to wash your hair.1

Wrist

Like the hands and feet, the wrist is one of the earlier and more commonly affected joints in people with RA. Inflammation of the wrist can make it difficult to bend your wrists, and your wrists may be painful and stiff.3

Why does RA cause joint pain?

Rheumatoid arthritis is an autoimmune condition. This means that the body’s immune system attacks its own healthy tissues. RA specifically affects the synovial joints, which are joints between bones that move against each other.2,7

RA usually starts in the smaller joints, like those in the hands and feet. It is sometimes symmetrical, which means it usually affects the same joints on both sides of the body. As the condition gets worse, ligaments, joints, and cartilage become more damaged. This leads to increased pain, as well as deformities.2,7

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, like an infection. This causes the immune system to start attacking the joints.2,7

How are RA joint symptoms managed?

Although there is no cure for RA, there are a range of treatment options for the inflammation, pain, and stiffness that affect the joints. Treatment depends on your symptoms and how severe they are. The goals of treatment are to:7,8

  • Stop or reduce inflammation
  • Relieve symptoms
  • Prevent joint and organ damage
  • Improve function and well-being
  • Reduce long-term complications

Doctors usually use a combination of medicines, lifestyle changes, and surgery.

Medicines to manage managing RA joint pain

Different medicines are used to relieve the pain and inflammation of RA, and stop the condition from getting worse. They are often used together.

Over-the-counter medicines (OTC) medicines like aspirin, ibuprofen, or nonsteroidal anti-inflammatory (NSAIDs) are often recommended to help reduce inflammation, swelling, and pain.1

Immunosuppressants (drugs that control your immune system) may also be used for RA. Traditional disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate, or biologic DMARD treatments can help reduce joint inflammation while slowing or preventing joint damage.1

Lifestyle changes to managing RA joint pain

There are a number of things you can do to help manage your RA joint pain, including:3

  • Get regular, gentle exercise. This can strengthen muscles around your joints. Your doctor might have you work with a physical therapist to develop a plan that is right for you.
  • Maintain a healthy weight and eat a balanced diet
  • Use heat and cold to relax muscles and numb pain
  • Use devices and tools that make your life easier and reduce your pain. This includes canes and orthopedic shoes to help with walking, special cutlery and dishes to make eating and drinking easier, and specially designed keyboards to help with typing.

Surgery to managing RA joint pain

Surgery is typically used only when damage to joints, cartilage, and bones has become severe. Types of surgery depend on location of the joint and the nature of the damage, but may include:3

  • Replacement (total or partial) of a joint (knee, hip, shoulder)
  • Surgery to improve alignment of joint (knee)
  • Arthroscopic surgery to repair or remove damaged tissue (synovectomy)
  • Fusion of bones with removal of the joint (cervical vertebra, ankle)
  • Surgery to correct joint damage (foot, hand, wrist)

Learn more surgery options for RA

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Written by: Jonathan Simmons & Heather Morse | Last reviewed: October 2020