The Early Signs of Rheumatoid Arthritis

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Rheumatoid arthritis (RA) is a systemic, autoimmune disease in which the body's own immune system attacks healthy tissues. RA most commonly affects the connective tissue surrounding joints (synovium), leading to the classic symptoms of joint swelling and stiffness.

However, since RA can affect various organs of the body, a wide array of nonspecific symptoms may develop. This is especially true in the early stages of the disease, when people may experience vague and general symptoms. In turn, this can lead to a delay in receiving treatment.

This article discusses how to identify some of the more common early signs and symptoms of RA, as well as when to see a healthcare provider.

Rheumatoid arthritis can give hand and wrist pain

Grace Cary / Moment / Getty Images

Early Signs of RA

With over 100 different forms of arthritis, it is not uncommon—especially early in the disease—for symptoms to be ignored or even misdiagnosed. However, over time, more specific signs and symptoms begin to arise.

The following are some of the early signs of RA.

Fatigue

Fatigue is generally characterized as a feeling of extreme tiredness or a lack of energy and motivation, either physically, emotionally, or mentally. The fatigue people with RA experience tends to be more severe than that caused merely from a lack of sleep.

While there are many psychosocial elements that can contribute to feelings of fatigue, current evidence has shown that RA treatment with certain biologic medications can influence fatigue. The fact that biologic medications have been seen to reduce the level of fatigue in people with RA suggests the significant role systemic inflammation plays in the development of fatigue.

In addition to inflammation, being diagnosed with a lifelong autoimmune illness can be life changing. Without proper support and management, people can feel overwhelmed, anxious, and depressed.

All of these feelings can contribute to debilitating fatigue and should be addressed routinely during healthcare visits.

Fever

In addition to nonspecific symptoms such as fatigue and a general feeling of not being well (malaise), some people with RA may start to experience low grade fevers of between 99 and 100 degrees Fahrenheit.

While RA typically targets the synovium (the tissue lining the inside of the joint capsule), the overall increase in immune system activity can, at times, lead to the development of a fever. This is in an attempt to rid the body of what it falsely perceives as a foreign invader.

It's unlikely that RA will lead to high fevers, so if one develops, it's crucial to seek medical attention to rule out the presence of an underlying infection. People with RA on certain medications may be more susceptible to severe infection.

Joint Stiffness

A key differentiating feature of RA compared to other forms of arthritis is that people with RA tend to experience joint stiffness. This stiffness is usually worse in the morning and improves with activity or use. In fact, asking how long a person's morning stiffness lasts is a routine question asked by healthcare providers and rheumatologists.

People with untreated or undertreated RA will note stiffness lasting longer than one hour. People with RA and even osteoarthritis (OA) may also experience increased joint stiffness after long periods of inactivity, something known as the gelling phenomenon.

The most commonly affected joints tend to be the small joints of the hands, wrists, and feet, although any and all joints may be affected.

Stiffness in OA vs. RA

People with osteoarthritis may experience morning joint stiffness lasting only a few minutes. Instead, joint pain in OA tends to worsen with use, increasing by the end of the day. In RA the opposite is true. Joint stiffness is worse in the morning and tends to improve with use as the day goes on.

Joint Redness and Swelling

RA is a systemic (whole-body) inflammatory disease, which tends to target the joints and their surrounding tissues. Inflammation within the synovium can lead to joint redness, swelling, and warmth, not to mention pain and stiffness.

The intensity of joint redness and swelling is directly related to the amount of underlying inflammation within the joint.

Joint Swelling in RA vs. PsA

In psoriatic arthritis (PsA), people tend to develop widespread swelling of their whole finger, known as dactylitis. That is not the case in RA, in which swelling typically remains localized in the metacarpophalangeal (MCP) joints (the knuckle where the finger bones meet the hand bones) and proximal interphalangeal (PIP) joints (the middle knuckles).

Joint Pain and Tenderness

Pain or tenderness of the joints is typically caused by inflammation within the joint space. This can lead to swollen joints, which become painful to touch and with certain movements. Reducing the inflammation can help decrease the pain and tenderness.

Joint Warmth

As already mentioned, the inflammatory nature of RA lends itself to the development of warm and tender joints. Depending on the severity of disease and the amount of inflammation present, a person may actually feel warmth emanating from their joints.

Joint warmth is commonly observed when a person is having an RA flare-up (times when symptoms worsen).

Numbness and Tingling

The sensation of numbness and tingling, along with a pins-and-needles sensation (known as paresthesias), is a common neurological symptom.

In people with RA, inflammation of a joint may spread out to surrounding nerves and cause numbness and tingling. One common place this occurs is in the wrists.

Inflammation surrounding the median nerve can lead to carpal tunnel syndrome, which includes symptoms of numbness and tingling of the thumb, index, middle, and half of the ring finger.

Weight Loss

While no definitive link between RA and weight loss has been noted, one possible explanation could be that when people are in pain, they tend to have a decreased appetite. Therefore, in the early stages of disease, prior to diagnosis and treatment and during intermittent flare-ups, people may experience weight loss with no other known cause.

A review of patients who experienced weight loss of over 30 pounds around the time of RA diagnosis were found to have a higher mortality rate when compared to people with stable weight.

Unexplained Weight Loss

Anyone who develops weight loss without changes in diet or exercise should consult with their healthcare provider, as it may be a sign of a serious medical condition.

Decreased Range of Motion

With greater levels of inflammation noted throughout the body and within the joint spaces, people may begin to experience joint tightness or a decreased range of motion.

Commonly, people complain of being unable to make a fist or hold on to a pen properly. When larger joints are involved, like the knees, people may notice a decreased ability to flex or extend at the knee joint.

Decreased range of motion of the joints is directly related to the level of inflammation affecting them. However, in later disease, chronic and persistent joint inflammation can lead to permanent joint damage and destruction, leading to permanent decrease in flexibility and mobility of the joints.

When to See a Healthcare Provider

The current diagnostic criteria for RA depends on:

  • Which joints are affected (large vs. small)
  • Number of joints affected
  • Inflammatory markers
  • Presence or absence of a rheumatoid factor or anti-citrullinated (ACPA) antibody
  • Duration of symptoms lasting longer or shorter than six weeks

If you have been experiencing joint pain and stiffness that's worse in the mornings and lasts for more than one hour, along with any of the symptoms mentioned in this article, it may be time to seek the expertise of a healthcare provider.

Rapid and accurate RA diagnosis can lead to proper management and treatment of the disease, which can ultimately slow or halt progression and lead to symptom relief. Undiagnosed or untreated RA can lead to permanent disability and premature death.

Summary

Rheumatoid arthritis is a complex, autoimmune disease that causes inflammation of the joints, heart, lungs, skin, and more. No one with RA will have the same exact disease course or experience the same symptoms.

Some early signs and symptoms of RA include, but are not limited to, fatigue, low-grade fevers, joint pain, stiffness, and swelling, and paresthesias. Working with a rheumatologist will ensure that RA is managed and treated effectively, leading to symptom relief and delayed disease progression.

A Word From Verywell

If you think you're experiencing RA symptoms, seek an evaluation by a primary care provider or a rheumatologist. Diagnosing RA early can help with symptom relief and delay progression of the disease through an adequate treatment plan.

Frequently Asked Questions

  • Can you test for rheumatoid arthritis at home?

    While there are some companies that offer at-home blood test kits checking for certain serological markers of RA, home tests can't replace a proper diagnosis made by a licensed healthcare provider. If you think you may have RA, see a rheumatology specialist. Rheumatologists can help determine which, if any, inflammatory arthritis you may be suffering from.

  • What are the first signs of rheumatoid arthritis?

    RA looks and feels different to each and every person affected by the disease. Early signs may be very nonspecific and vague. Some of the commonly seen early signs of RA are fatigue, fever, joint pain, swelling, and stiffness, along with decreased range of motion and weight loss.

  • What happens if rheumatoid arthritis goes undiagnosed and untreated?

    While RA primarily targets the joints, it is known to affect other organs in the body, such as the heart, lungs, and skin. Since RA is a systemic, total body disease, untreated inflammation throughout the body can lead to long-term disability and organ damage. That's why it's important to see a healthcare provider if you suspect RA.

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