Signs and Symptoms of RA

Symptoms of rheumatoid arthritis vary from patient to patient. They can develop suddenly, develop slowly over time, or occur sporadically with intervening times of having no symptoms. Signs of the disease, such as joint pain and stiffness, often develop first in the small joints in the fingers, hands, wrists, and feet. The distal interphalangeal (DIP) joints (i.e., joints closest to the finger tips) usually are not affected.

In most cases, joint pain and stiffness are more severe following periods of inactivity and upon waking in the morning. In addition to the hands and wrists, joints that are commonly affected by RA include the cervical spine (neck), shoulders, elbows, hips, and knees. The joint that controls movement of the vocal cord, which is called the cricoarytenoid also may be affected, causing hoarseness and, in severe cases, difficulty breathing.

Joint involvement usually is symmetrical, which means that if the symptom develops in a joint on one side of the body, it also may occur in the same joint on the other side of the body.

As rheumatoid arthritis progresses, damage to cartilage, tendons, ligaments, and bone can cause deformity and joint instability. This damage can result in loss of joint function, which often leads to difficulty performing every day tasks (e.g., buttoning a shirt, opening a jar).

In addition to joint pain and stiffness, symptoms of RA include the following:

  • Anemia (low red blood cell count)
  • Depression
  • Fatigue
  • Flu-like symptoms (e.g., low-grade fever, malaise)
  • Loss of appetite and weight loss
  • Muscle pain
  • Weakness

Rheumatoid nodules or synovial cysts (lumps of tissue under the skin) may indicate severe disease. Most of the time, rheumatoid nodules do not cause pain, but sometimes they can occur in areas that can cause irritation. Rheumatoid nodules and synovial cysts may cause pressure on surrounding nerves and can rupture, causing pain and discomfort in surrounding tissue. Lesions and ulcers (sores) on the skin also can occur.

Rheumatoid Arthritis Complications

RA can affect the glands located near the eyes and mouth, resulting in a condition called secondary Sjögren's syndrome. Decreased tear and saliva production can cause dry mouth, and dry eyes. RA can also cause inflammation of the sclera (white part of the eye), which may make the sclera appear red or bluish in color.

Felty's syndrome is a complication of rheumatoid arthritis. Signs of this condition include an enlarged spleen (splenomegaly) and an abnormally low white blood cell count (particularly neutrophils). In severe cases, the spleen must be removed.

RA also may cause lung (e.g., pleural effusion, fibrosis, nodules, pneumonia) and heart (e.g., pericardial effusion, pericarditis) complications. Patients who have RA may be at increased risk for heart attack (myocardial infarction). RA patients over all develop heart attacks on average 10 years earlier than their peers, so monitoring of blood pressure and cholesterol, and treatment if necessary, are very important.

Publication Review By: Donald E. Thomas, Jr., M.D., FACP, FACR, Stanley J. Swierzewski, III, M.D.

Published: 01 Jun 2006

Last Modified: 09 Jan 2012