10+ Early Signs and Symptoms of Rheumatoid Arthritis - Verywell Health
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Rheumatoid arthritis (RA) is a type of inflammatory arthritis that primarily affects the joints of the hands, wrists, and knees, but any joint in the body can be affected. For some people, RA can damage other body systems, including the skin, eyes, heart, and blood vessels.
RA is an autoimmune disease, which means it results from the immune system mistakenly attacking healthy tissues. It is characterized by damaging inflammation.
Left untreated, RA can cause bone erosion and joint deformity. Inflammation can also damage other parts of the body. The risk for damage to the joints and other parts of the body is why early diagnosis and aggressive treatment in RA are vital.
In this article, we will cover the earliest symptoms people with RA might experience, their frequency, as well as complications, and more.
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Frequent Symptoms
The earliest signs and symptoms of RA will come on gradually, some even before joint pain and stiffness become noticeable.
Fatigue
Before experiencing any other symptoms of RA, early on, people with the condition will feel extremely tired and lack energy. Fatigue is the body's response to inflammation affecting the joints and other parts of the body. The majority of people with RA report fatigue, and it is one of the most challenging symptoms to manage.
Fatigue linked to RA is different than usual tiredness. People with RA often describe this type of fatigue as overwhelming and unpredictable. They feel worn out and drained of energy.
Malaise
Malaise is an overall feeling of discomfort or illness—like you are unwell. It includes symptoms such as weakness, mild nausea, fatigue, lack of appetite, and sensitivity to smells.
As an early symptom of RA, malaise occurs because the immune system has turned against the body's tissues, attacking the joints and causing inflammation, pain, and swelling. All of these effects tire the body and result in malaise.
Reduced Ranged of Motion
In early RA, the joints are only mildly restricted. As RA advances, limited range of motion results from swelling and weakness in the joints.
Joint movement becomes harder, and balance is affected. The reduced range of motion might also cause limping and losses of coordination, grip, and dexterity, even in the early stages.
Symmetrical Disease
RA is a symmetrical disease—that is, it affects similar joints on both sides of the body. In other words, if your right hand is affected, so is your left hand. Or, if your right knee is affected, chances are your left knee will be as well.
Symmetrical joint involvement is a classic feature of RA. However, there are times in which RA is asymmetrical, especially early on. RA that affects multiple joints without symmetry is referred to as asymmetric polyarticular form arthritis.
Multiple Affected Joints (Polyarthritis)
RA—even in early stages—affects multiple joints. When arthritis affects four or more joints, it is called polyarthritis.
RA can affect only a few joints early on, but it rarely affects a single joint—at least not in adults. Both oligoarthritis (arthritis affecting less than four joints) and monoarthritis (single joint) are common in childhood inflammatory arthritis.
Joint Problems
Joint pain, swelling, tenderness, stiffness, redness, and warmth are all ways in which RA affects the joints.
Pain: Joint pain in RA results from inflammation that is present when the disease is active. It can also occur when RA is inactive or controlled but joint damage is present.
Swelling: When RA flares up (is active), the joints swell because of thickening of the joint synovium (linings of the joints) and excess joint fluid. In RA, the joint lining is a target of the immune system's overactive response.
You can usually tell when your joints are swollen. For example, swelling in larger joints can affect your range of motion, or swelling of the fingers can make it harder to remove rings.
Tenderness: RA causes joint tenderness due to irritation in the nerves of the joint capsule, the sleeve of fibrous connective tissue around a joint. When the irritated joint capsule is compressed by external pressure (such as by touching), the joint is tender, and the pain is immediately felt.
Stiffness: Joint stiffness is common in RA. Joints affected by active RA become inflamed and stiffen up in the morning or after long periods of inactivity. The length of time your morning stiffness lasts will indicate to your how severe your inflammation is. This symptom tends to improve with treatment.
Redness: Redness can sometimes be seen in the skin over inflamed joints. The redness results from dilated (widened) skin capillaries (tiny blood vessels) due to nearby inflammation. Joint redness is not always present, especially if inflammation isn't severe.
Warmth: Joint warmth is a sign of active inflammation in RA. Warmth is sometimes present without visible swelling and redness. It is also a symptom that resolves once RA responds to treatment.
Affected Joints
Early on, RA affects your smaller joints, especially your finger and toe joints. As the disease progresses, people with the condition will experience symptoms in the larger joints, including the knees, ankles, wrists, elbows, hips, and shoulders. For most people, joint symptoms will affect the same joints on both sides of the body.
Certain joints are more commonly affected by RA. These typically are the joints that contain synovial lining.
While RA can affect any joint with a synovial lining, it frequently and more severely affects the joints most commonly used—the fingers, wrists, knees, ankles, and feet—in the following ways:
- Fingers: RA commonly affects the knuckles at the middle and base of the fingers. When RA affects the finger joints, things like gripping objects and using the fingers for repetitive tasks become more difficult. RA that affects the hands can cause hand weakness and dexterity loss (the ability to perform tasks with reasonable ease).
- Wrists: The wrists can be affected early in the disease. Wrist involvement in RA also affects the forearm, the lower part of the arm containing the radius and ulna bones. Repetitive motion in RA can cause the wrists to become severely inflamed.
- Knees: RA often affects both knees. Being overweight and having a sedentary lifestyle can increase knee pain and stiffness, as can repetitive use and high-impact exercise during flares.
- Ankles: If RA affects one ankle, chances are your other ankle is affected, too. RA causes inflammation and stiffness in the ankle joints and with time, the ankle joints will have permanent changes to their shape.
- Feet: RA affects the joints of the toes and the balls of the feet. There are many small joints in the feet, and they are some of the first joints affected by RA.
Rare Symptoms
Some people aren't aware of the symptoms that are less common with RA. These are symptoms that affect only some people with RA.
Low-Grade Fever
Mild low-grade fevers affect some people with RA when the disease is actively causing inflammation. A low-grade fever ranges from 99.6 to 100.3 degrees Fahrenheit. A low-grade fever linked to RA inflammation usually corrects as soon as the inflammation resolves.
One 2018 report in the journal Clinical Medicine reports fever is common in people who have more aggressive disease that affects multiple joints and where synovitis (inflammation of the joint linings) is present.
Limping
Limping occurs in RA when the condition affects the hips, knees, ankles, or feet. In early RA, limping is less common because the larger joints are not yet affected or inflammation of the ankles of the feet isn't significant enough.
However, some people in early RA can experience severe pain, loss of function, and joint swelling that leads to a noticeable limp. A painless limp might occur in small children as a first sign of the disease.
Anemia
Chronic inflammation in RA can cause the bone marrow to decrease its release of red blood cells (RBCs). The reduced number of RBCs results in anemia when RA is active and disease activity is high. It is not unusual for the anemia caused by RA to resolve when inflammation subsides.
Weight Loss and Loss of Appetite
A consequence of pain, fatigue, and fever is loss of appetite, which can lead to weight loss. Anytime you experience weight loss without trying to eat better and be active, you should talk to your doctor.
Complications/Subgroup Indications
Complications of RA are not true symptoms of the condition. They are often consequences of severe and untreated disease. In RA, the same inflammatory process that affects the joints can cause problems with the eyes, lungs, skin, heart, blood vessels, and other organs.
Some possible complications of RA are:
- Rheumatoid nodules: Some people with RA may experience lumps of tissue that appear on the skin called rheumatoid nodules. Lumps can appear anywhere on the skin, including on the elbows, fingers, and heels. These show up suddenly and grow slowly. Rheumatoid nodules are a sign that your RA is getting worse.
- Blood vessel inflammation: RA can cause a condition called rheumatoid vasculitis, which is inflammation of the blood vessels. Vasculitis can cause ulcer-like skin spots to appear on the skin. If vasculitis affects large arteries, it can cause nerve damage that might affect the arms and legs or cause damage to the internal organs.
- Eye inflammation: RA inflammation can affect various parts of the eyes, including the episclera (the thin membrane covering the white of the eye) and the sclera (the white of the eye). For many, these conditions can cause redness and pain, but they can also become serious and lead to vision loss.
- Lung disease: People with RA have an increased risk for inflammation and scarring of lung disease. RA can also cause lung nodules, pleural disease (inflammation of the linings of the lungs), and small airway obstruction (as the result of chronic inflammation in the walls of the lungs).
- Carpal tunnel syndrome: If RA affects the wrists, inflammation might eventually compress the nerve serving the hands and fingers, called the median nerve.
- Heart problems: RA inflammation can affect the heart and blood vessels, raising the risk for heart disease. People with RA have a 50% greater risk for heart disease compared to others in the general population.
You can decrease your risk for RA complications by following your treatment plan. You should also let your doctor know about any new or additional symptoms that arise, no matter how small they seem.
When Do the Signs of RA Start?
Rheumatoid arthritis affects 1.3 million people in the United States. It is 2.5 times more common in women. RA often affects people between the ages of 20 and 50, but young children and older adults can also have RA.
Younger adults and older adults, who make up a smaller number of the people RA, often have a different disease course than people in middle adulthood.
Young Adulthood
RA is more likely to affect people in middle age, but young adults are also commonly affected. According to the Cleveland Clinic, RA affects eight in 100,000 young adults ages 18–34.
RA can be more severe in young adults. This group might be more likely to have inflammation of the small joints of the hands and feet, bony erosions, and rheumatoid nodules. RA in young adults can also have strong emotional effects, especially as young adults come to terms with the long-term nature of the condition.
Older Adults
RA that starts after age 60 is called elderly-onset RA or late-onset RA. The percentage of people who develop RA later in life is around 10%–33% of all RA cases.
Women and men get elderly-onset RA at close to the same rate. In younger people, women are more likely to develop RA.
Symptoms in older adults tend to come on quickly and affect mainly the larger joints, including the shoulders. Rheumatoid factor (RF)—a protein common in RA and responsible for the immune system's attacks on healthy tissues—is less common in elderly-onset RA.
For the most part, elderly-onset RA tends to be less severe. But some older adults with RF will have a more severe disease course.
When to See a Doctor
If you have early signs of rheumatoid arthritis, see their healthcare professional as soon as possible. A doctor can diagnose the condition and recommend treatments. If necessary your primary care doctor can refer you to a doctor who specializes in the treatment of arthritis, called a rheumatologist.
Early diagnosis and treatment can help manage RA and slow its progression, which may reduce or delay some of the complications. The condition will need to be managed for the rest of your life,
Summary
Rheumatoid arthritis is a condition characterized by joint inflammation. It commonly affects the joints of the hands, fingers, feet, and knees. The earliest signs and symptoms can be mimicked by other conditions, but because they often appear together, they are considered specific characteristics of the condition.
Early signs of RA include joint problems, such as pain, tenderness, swelling, warmth, redness, and stiffness. Additional signs include fatigue, malaise, loss of range of motion, limping, anemia, low-grade fever, disease symmetry, and multiple affected joints.
A Word From Verywell
There is no cure for RA, but there are many effective treatments that can decrease pain, slow down disease progression, and reduce the potential for joint damage and disability. Early diagnosis and treatment are also vital to reducing the risk for complications from the condition.
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