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Joint Swelling, Tightness or Stiffness

The most common symptoms in RA are those affecting joints throughout the body, including inflammation, pain, swelling, and tightness or stiffness. Joint involvement may be limited to the hands and feet early in the course of the disease. However, other joints throughout the body may become affected as the disease progresses, including the ankles, knees, hips, elbows, shoulders, and the neck.1

Joint involvement in RA assumes a characteristic pattern, with symptoms affecting the same joints on both sides of the body. For instance, a patient with RA may experience joint pain and swelling in both hands, knees, or hips. RA may not begin with symmetrical joint involvement, but as the disease progresses joints on both sides of the body will be affected.1

Joints of the hands and feet

Joints in the hand tend to be affected early in the course of RA and will be tender when squeezed or during movement and a decrease in grip strength will be evident. In some patients, there may be 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. 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

Similar to the hands, feet 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.1

Wrist, elbow, and shoulder

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 the wrist forward and back. RA also affects the elbow, which may become inflamed and swollen causing nerve compression that results in numbness and tingling in the fingers. Pain and inflammation affecting the shoulder may result in a limitation of movement and tends to occur only in the later stages of RA.1

Ankle, knee, hip

In RA, joints in the ankle may become inflamed and swollen. This inflammation and swelling can eventually lead to nerve damage, resulting in numbness and tingling in the feet. Involvement in large joints, such as the knee and hip, tends to occur in later stages of RA. The knee may swell, making it difficult to bend and move. Swelling and inflammation of the hips may make it difficult to walk.1

Cervical spine

In addition to the joints of our hands and feet and the large joint that we depend on for mobility, RA may also 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 a person to turn their head and bend their neck.1

How are RA joint symptoms managed?

There are a range of treatment options for the inflammation, pain, and stiffness that affects the joints in RA. Choice of treatment will depend on the nature and severity of symptoms and joint damage.

Typically, the initial treatment approach involves drugs that address pain and inflammation and slow or prevent joint damage. Pain medications include analgesics, such as non-steroidal anti-inflammatory drugs (NSAIDs]). Glucocorticoid treatments, which can be taken orally, injected into a vein, or injected directly into an affected joint, are effective at controlling inflammation that occurs during disease flares. Disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate, or the newer biologic treatments are effective at decreasing joint inflammation and slowing or preventing damage to joints and related structures.

Other non-drug interventions are an important part of joint symptom management. These include a wide variety of techniques and approaches, including:

Surgical interventions are typically used only when damage to joints and related structures (eg. cartilage, bones) has become severe. Types of surgery vary according to the location of the joint and the nature of the damage, but may include:

  • 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

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.