By understanding the signs and symptoms of rheumatoid arthritis, you can seek diagnosis and treatment early before 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 hands 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 Cause the bonding (“tethering”) of joints, further restricting your 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 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:
RashesUlcersBlisters
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 Hormonal imbalance
Biological males with rheumatoid arthritis are, according to research, 67% more likely to experience erectile dysfunction (ED) than men without the disease.
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.
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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.
Pain, swelling, or stiffness in one or more jointsJoints that are red or warm to the touchRegular joint stiffness in the morningDifficulty moving a joint or doing daily activitiesAn episode of increased joint pain and stiffness lasting for more than three days
