Symptoms of Rheumatoid Arthritis

Pain, swelling, and stiffness of several joints are classic signs and symptoms of rheumatoid arthritis, and all of them stem from the disease's chronic inflammatory nature. Persistent inflammation can, over time, lead to the progressive loss of mobility, worsening bouts of illness, and joint deformity. The heart, lungs, eyes, and circulatory system can also become affected, bringing about other symptoms and increasing the risk of disability and death.

By understanding the signs and symptoms of rheumatoid arthritis, you can seek diagnosis and treatment early before the more serious complications develop.

Initial Symptoms

What makes rheumatoid arthritis so confounding is that no two cases are alike. While some will develop gradually with sustained periods of remission, others strike fast and hard.

Generally speaking, the first signs of the disease tend to be vague—maybe a dull ache or stiffness that disappears with gentle movement.

The smaller joints are usually the first affected, such as those of the hand or feet. In cases like these, the symptoms will most often be chronic, progressing gradually but persistently with occasional flare-ups.

However, this isn't always the case. In about 10% to 20% of patients, the initial symptoms will be sudden and intense, followed by a prolonged period with no symptoms at all. Others may have intermittent symptoms that come and go with a certain regularity.

While the disease may initially involve only one joint (monoarthritis), it will usually affect additional joints over time (polyarthritis).

The pattern of the affected joints, meanwhile, will most often be symmetrical, meaning that any joint affected on one side of the body will be affected on the other.

Symptoms of Disease Progression

Rheumatoid arthritis is a chronic, progressive disorder. Unless the underlying inflammation can be brought into remission, the disease will continue to advance, causing not only pain and stiffness but undermining the integrity of the joint itself.

Over time, the relentless autoimmune response can deteriorate joint cartilage, erode bone tissue, and cause the bonding ("tethering") of joints, further restricting the range of motion. This is especially true of weight-bearing joints in which damage can result in the loss of mobility, such as the knees.

Edema, the swelling of tissue caused by fluid retention, is also common. With rheumatoid arthritis, swelling is typically associated with inflamed joints of the feet, ankles, legs, arms, and hands.

Eventually, as their structural underpinnings are destroyed, the joints will begin to lose their shape and alignment, resulting in joint deformity.

Common examples of this include:

• Ulnar deviation: Deformity of the big joints in the knuckles
• Joint contracture: The restrictive foreshortening of muscles around a joint
• Wrist subluxation: Dislocation and misalignment of the wrist bones

It is usually at this stage that other, more potentially serious complications can develop.

Complications

Unlike osteoarthritis ("wear-and-tear" arthritis), in which inflammation is localized, rheumatoid arthritis involves systemic (whole-body) inflammation. This means that more than just the joints can be affected in RA.

Skin and Mucous Membranes

Around 20% of people with rheumatoid arthritis will develop hardened bumps beneath the skin called rheumatoid nodules. They most often develop on the elbows, knees, or knuckles.

Another condition, known as Sjögren's syndrome, affects anywhere from 4% to 31% of rheumatoid arthritis sufferers. It involves dry eyes, dry mouth, vaginal dryness, and dry skin.

Several skin-related symptoms may develop in later-stage disease, including:

• Rashes
• Ulcers
• Blisters

Cardiovascular Complications

RA is associated with a few problems involving the heart and circulation, including:

• Pericarditis, inflammation of the membrane surrounding the heart
• Vasculitis, constriction of capillaries that may cut off circulation
• Increased risk of stroke and heart attack

Your healthcare provider can help you find ways to lower your risk of these possible complications.

Lung Complications

While uncommon, lung-related complications can be life-threatening. Possible complications include:

• Pleuritis, inflammation of the lining around the lungs
• Chronic obstructive pulmonary disease (COPD), especially in smokers
• Interstitial lung disease, inflammation and scarring of the lungs

Eye Complications

Sjögren's syndrome is the most common cause of rheumatoid arthritis-related eye complications. The long-term dryness of the eye can often lead to scarring, ulceration, infection, and even perforation of the cornea.

Scleritis is another eye complication caused by the inflammation of the sclera (the white of the eye). Left untreated, scleritis can permanently damage the eyeball, leading to vision loss.

Sexual Dysfunction

Broadly speaking, studies suggest that sexual dysfunction affects anywhere from 31% to 76% of people with arthritis. Causes may include pain, fatigue, stiffness, depression, anxiety, negative body image, reduced libido, and hormonal imbalance.

Men with rheumatoid arthritis are, according to research, 67% more likely to experience erectile dysfunction (ED) than men without the disease.

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When to See a Healthcare Provider

Rheumatoid arthritis can be scary, and not only because of the symptoms but because of the uncertainty of what lies ahead. Don't let this stop you from taking action if you suspect you have the disease.

The advantage of an early diagnosis is that it allows you early treatment. Simply put, the sooner you take disease-modifying medications, the better your long-term outlook is.

This is especially true if you have a family history of rheumatoid arthritis. Having a sibling or parent with rheumatoid arthritis nearly triples your risk of the disease, while having a second-degree relative doubles your risk.

Frequently Asked Questions

How is RA diagnosed?

RA can be difficult to diagnose but diagnosis begins with a physical examination and detailed medical history. Healthcare providers will also order lab tests to look for disease identifiers and inflammatory markers in the blood. Finally, imaging tests can determine the extent of joint damage. Together, these tests can determine the level of disease in a patient and how to move forward with treatment.

What age range is usually affected by rheumatoid arthritis?

RA can present at any age, but it is more common as a person gets older. Onset of this disease is most common in adults over 60.

What treatment options are available for RA?

There are medications that help manage RA symptoms and control inflammation, such as NSAIDs, corticosteroids, disease-modifying anti-rheumatic drugs, and biologics. However, there are non-medication treatment options as well. Non-pharmacologic treatment options include rest, exercise, physical and occupational therapies, dietary management, and, in some cases, surgery.