Symptoms of Rheumatoid Arthritis

Rheumatoid arthritis is a chronic inflammatory disease characterized by the pain, swelling, and stiffness of several joints. The persistent inflammation can lead to the progressive loss of mobility, worsening bouts of illness, and joint deformity. Over time, the heart, lungs, eyes, and circulatory system can also become affected, 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.

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.

But, this is not always so. In about 10 percent to 20 percent of cases, 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.

The early signs and symptoms of rheumatoid arthritis include:

• Joint pain, swelling, and stiffness
• Warmth and redness around the affected joint
• Morning stiffness that usually lasts longer than 30 minutes
• Fatigue and malaise (a general feeling of unwellness)
• Low-grade fever and, occasionally, flu-like symptoms

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.

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 will deteriorate the 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 the structural underpinnings of a joint are destroyed, it will begin to lose its 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.

Unlike osteoarthritis ("wear-and-tear" arthritis), rheumatoid arthritis will not only affect the joints but cause systemic (whole-body) inflammation that can impact every organ system in the body.

Skin and Mucous Membranes

Around 20 percent to 30 percent of people with rheumatoid arthritis will develop hardened bumps beneath the skin called rheumatoid nodules. They can be as small as a pea or as large as a walnut and most often develop on the elbows, knees, or knuckles. Rashes, ulcers, and blisters can also common in later-stage disease.

Another condition, known as Sjögren's syndrome, involves the inflammation of tear ducts and salivary glands. The swelling of these tissues can reduce the volume of tears and saliva, leading to dry eyes and dry mouth. Vaginal dryness, dry skin, a persistent cough, and fatigue are also common. Sjögren's syndrome affects between 10 percent and 15 percent of rheumatoid arthritis sufferers and can lead to dental cavities, yeast infections, and vision problems.

Cardiovascular Complications

Pericarditis, the inflammation of the membrane surrounding the heart, is characterized by chest pain and the accumulation of fluid (pericardial effusion). Fatigue, shortness of breath, and the development of nodules are also common.

In addition to the heart inflammation, rheumatoid arthritis can affect the blood vessels and lead to a complication known as vasculitis. Vasculitis is characterized by the constriction of capillaries to the point where circulation may be cut off. The most common signs of vasculitis are leg ulcers and dead, black tissue beneath your fingernails called digital infarcts. Vasculitis can also affect the nerves of your hands and feet, triggering a numb, burning, and tingling sensation. Fever, fatigue, weight loss, and muscle and joint pain are also common.

Lungs Complications

Inflammation of the lining around the lungs, called pleuritis, can lead to a buildup of fluid and the restriction of breathing. Over time, inflammation and the development of nodules can cause severe scarring (fibrosis) of the pleural lining. Smokers with rheumatoid arthritis are hit especially hard by this and are more likely to develop chronic obstructive pulmonary disease (COPD) than their non-smoking counterparts.

Symptoms of pleuritis include chest tightness, shortness of breath, rapid breathing, and a dry cough.

Rheumatoid arthritis can also cause inflammation and scarring of the lungs themselves (interstitial lung disease). Symptoms include shortness of breath and cough.

While uncommon, these complications can be life-threatening.

Eye Complications

Sjögren's syndrome is the most 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 of RA. It is caused by the inflammation of the sclera (the white of the eye). The disease is characterized by pain and redness of the eye. Left untreated, scleritis can permanently damage the eyeball, leading to vision loss.

Sexual Dysfunction

Rheumatoid arthritis may affect sexual function both directly and indirectly. Broadly speaking, studies suggest that sexual dysfunction affects anywhere from 31 percent to 76 percent of people with arthritis. The causes of this are multifactorial and may include pain, fatigue, stiffness, depression, anxiety, negative body image, reduced libido, and hormonal imbalance.

Among some of the factors that can directly interfere with sexual function:

• Joint pain and fatigue during sex is the main form of sexual disability, affecting anywhere from 50 percent to 61 percent of people with rheumatoid arthritis.
• Hip and knee pain can make it difficult to assume certain sexual positions.
• Sjögren's syndrome can cause vaginal dryness and lead to pain during intercourse.

While as many as 50 percent of people with rheumatoid arthritis report losses in sexual desire (libido), those losses are closely linked to low self-perceived quality of life (QOL) scores, which measured everything from bodily pain and social isolation to vitality and emotional state.

Similarly, while men with rheumatoid arthritis are 67 percent more likely to experience erectile dysfunction (ED) than men without the disease, it is unclear which factors contribute to this. Some scientists suspect that vascular inflammation may decrease the blood flow to the penis, although there has not yet been any direct evidence of this in research.

On the other hand, rheumatoid arthritis medications, which some suspected may cause sexual dysfunction, have not proven to directly interfere with sexual performance. If anything, the sustained control of symptoms was associated with increases in both QOL and sexual satisfaction.

Even in people with controlled rheumatoid arthritis, there can be moments when the pain and inflammation will suddenly flare. It may be triggered by overexertion, stress, a diminishing response to treatment, infection, or even certain foods we eat. At other times, there may be no known cause.

Flares can sometimes last for months before spontaneously resolving on their own or being brought under control with treatment.

The frequency and severity of these flares are important as they can provide clues as to how slowly or rapidly the disease is progressing and what the likely outcome (prognosis) may be.

Among the factors that can influence the prognosis:

• Being diagnosed at a younger age (under 40) or having had the disease for many years
• Having significant joint damage on diagnosis
• Strong positive results for anti-CCP on diagnosis
• Frequent, severe, or long-lasting flares
• Being a long-term, heavy smoker
• Obesity (a body mass index of over 30)
• An increase in the number of joints affected
• Poor disease management (including missed appointments, gaps in treatment, etc.)
• Uncontrolled inflammation as measured by the ESR and CRP
• General pain and stiffness that doesn’t improve

People who have some or many of these characteristics are more likely to experience serious illness unless the modifiable risk factors (such as smoking or drug adherence) can be changed.

Unfortunately, rheumatoid arthritis is associated with a reduced life expectancy due to the long-term disease complications.

Cardiovascular disease, which is often exacerbated by obesity, smoking, and other factors, remains the leading cause of death in people with rheumatoid arthritis. Research suggests that as many as 40 percent of deaths in people with rheumatoid arthritis can be directly attributed to cardiovascular events.

Having rheumatoid arthritis increases your risk of heart attack or stroke. Weight loss, exercise, and smoking cessation can greatly reverse those odds no matter what stage of disease you are in.

Rheumatoid arthritis can be scary, and not only because of the symptoms but 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 are placed on disease-modifying medications, the more positive your long-term outcomes will be.

To this end, you should see if a doctor if ever you experience the following symptoms:

• Pain, swelling, or stiffness in one or more joints
• Joints that are red or warm to the touch
• Regular joint stiffness in the morning
• Difficulty moving a joint or doing daily activities
• An episode of increased joint pain and stiffness lasting for more than three days

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 rheumatoid arthritis, while having a second-degree relative increases your risk two-fold.