People with rheumatoid arthritis may experience both physical and emotional symptoms.
RA often affects the joints in the hands and wrist first, though initial symptoms can also appear in the balls of the feet, knees, ankles, or other joints. Over time, more joints may be affected, most commonly the joints of the neck’s cervical spine, the shoulders, elbows, ankles, and jaw 1 Wolfe F, Katz RS, Michaud K. Jaw pain: its prevalence and meaning in patients with rheumatoid arthritis, osteoarthritis, and fibromyalgia. J Rheumatol. 2005 Dec;32(12):2421-8. PubMed PMID: 16331775. , and even joints between very small bones in the inner ear.
RA affects more than just joints. Body-wide symptoms, such as fever and fatigue, are possible. In addition, rheumatoid arthritis raises the risk for certain other physical and mental health conditions.
Signs and Symptoms of Rheumatoid Arthritis in Joints
RA inflammation in joints can usually be both observed (signs) and felt (symptoms). Inflammation is usually worse in the morning, lasting for an hour or more after getting out of bed. It may get better with light to moderate activity but still persist throughout the day.
RA inflammation can cause a joint to be:
- Stiff and difficult to bend or flex
- Warm to the touch
- Red in appearance
- Spongy or “boggy” when pressed
Joint involvement is usually symmetrical. For example, both the right and left wrists may be painful, stiff, and swollen.
Joint conditions directly related to RA inflammation include:
- Carpal tunnel syndrome, which can sometimes be caused by RA inflammation in the wrist.
- Tenosynovitis, particularly in the hand. Tenosynovitis is inflammation of the delicate synovial lining that surrounds a tendon. At least one study suggests that tenosynovitis of fingers’ flexor tendons is a strong predictor of rheumatoid arthritis. 2 Eshed I, Feist E, Althoff CE, et al. Tenosynovitis of the flexor tendons of the hand detected by MRI: an early indicator of rheumatoid arthritis Rheumatology (2009) 48 (8): 887-891 first published online May 27, 2009 doi:10.1093/rheumatology/kep136
- Rheumatoid nodules may form under the skin near joints. These nodules are firm bumps that range in size from pea-size to walnut-size and are mostly seen on or near elbows or fingers. Rheumatoid nodules are less likely to appear when RA is treated.
Symptoms can appear suddenly or gradually.
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Body-Wide Symptoms of Rheumatoid Arthritis
RA is a systemic disease, which means it affects the whole body. In addition to joint inflammation, common signs and symptoms of rheumatoid arthritis include:
- Excessive, whole-body fatigue that does not seem related to physical exertion or sleep
- A low-grade fever that is always or almost always present
- A general feeling of malaise or flu-like symptoms
- Unexpected weight loss and loss of appetite
- Loss of muscle and muscle weakness, which may show up early in the disease (note that muscle loss and weakness may persist even with successful treatment) 3 Farrow M, Biglands J, Tanner S, et al. Muscle deterioration due to rheumatoid arthritis: assessment by quantitative MRI and strength testing. Rheumatology (Oxford). 2021;60(3):1216-1225. PMID: 32910153 doi:10.1093/rheumatology/keaa364
Rheumatoid arthritis affects everyone a little differently, so signs and symptoms vary from person to person.
See How Rheumatoid Arthritis (RA) Causes Fatigue
Physical Conditions Linked to RA
People who develop rheumatoid arthritis are at greater risk for developing certain other physical medical conditions. These conditions can develop either before or after RA is diagnosed.
These conditions include:
- Hearing loss or tinnitus, 4 Emamifar A, Bjoerndal K, Hansen IM. Is Hearing Impairment Associated with Rheumatoid Arthritis? A Review. Open Rheumatol J. 2016;10:26-32. Published 2016 Mar 15. doi:10.2174/1874312901610010026 a condition that causes a ringing or buzzing in the ear
- Sleep apnea, 5 Reading SR, Crowson CS, Rodeheffer RJ, Fitz-Gibbon PD, Maradit-Kremers H, Gabriel SE. Do rheumatoid arthritis patients have a higher risk for sleep apnea?. J Rheumatol. 2009;36(9):1869-1872. doi: 10.3899/jrheum.081335 , 6 Shen TC, Hang LW, Liang SJ, et al. Risk of obstructive sleep apnoea in patients with rheumatoid arthritis: a nationwide population-based retrospective cohort study. BMJ Open. 2016;6(11):e013151. Published 2016 Nov 28. doi: 10.1136/bmjopen-2016-013151 a treatable condition that causes snoring, affects the body’s ability to take in oxygen while sleeping and contributes to fatigue
- Skin rashes, which may be related to rheumatoid vasculitis or medications to treat RA 7 Pasadyn SR, Knabel D, Fernandez AP, Warren CB. Cutaneous adverse effects of biologic medications. Cleve Clin J Med. 2020;87(5):288-299. doi:10.3949/ccjm.87a.19119
- Raynaud syndrome, a condition in which the tops of fingers or toes suddenly become numb and appear white or blue due to a temporary loss of blood circulation
- Gingivitis and gum disease, 8 Mercado FB, Marshall RI, Klestov AC, Bartold PM. Relationship between rheumatoid arthritis and periodontitis. J Periodontol. 2001 Jun;72(6):779-87. doi: 10.1902/jop.2001.72.6.779. PMID: 11453241. , 9 Bartold PM, Marshall RI, Haynes DR. Periodontitis and rheumatoid arthritis: a review. J Periodontol. 2005 Nov;76(11 Suppl):2066-74. doi: 10.1902/jop.2005.76.11-S.2066. PMID: 16277578. which can lead to gum damage and tooth loss
- Chronic insomnia—trouble sleeping—which may be linked to physical pain or mental health
- Lung problems that may cause shortness of breath and coughing
Lung problems tend to develop in long-standing RA and can be life-threatening. Prompt medical attention is recommended to help stop them from getting worse.
Only some people with RA experience the conditions listed above. Identifying and sticking to an effective treatment plan can help delay or prevent these conditions from developing. In addition, many of these conditions are treatable.
Mental Health Issues Linked to Rheumatoid Arthritis
Living with a chronic autoimmune disease, including but not limited to rheumatoid arthritis, can affect mental health and well-being. Rheumatoid arthritis may be accompanied by:
- Depression or anxiety
- Feelings of helplessness
- Low self-esteem
The combined physical and emotional effects of rheumatoid arthritis can impact work, social, and family life. Fortunately, early detection and appropriate treatment strategies, such as medications, occupational therapy, and counseling, can help. Most people with RA can live active, productive lives.