Early Symptoms of Rheumatoid Arthritis

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A Doctor's View on Early Rheumatoid Arthritis Symptoms

Comment by William C. Shiel Jr., MD, FACP, FACR

While the initial symptoms of rheumatoid arthritis can be very different from patient to patient, there are a number of symptoms that many people with rheumatoid arthritis confront. The appreciation of early symptoms of rheumatoid arthritis is extremely important for health-care professionals. By recognizing symptoms of early rheumatoid arthritis, the joint inflammation can be addressed before damage to the joints occur, thereby preventing long-term consequences of the disease. Moreover, because rheumatoid disease can affect other organs, early management can be used to optimize the health status throughout the body. Here I will first discuss the common early symptoms of rheumatoid arthritis and then review some unusual ones.

What are early symptoms of rheumatoid arthritis, and what areas of the body are affected?

While early symptoms of rheumatoid arthritis can actually be mimicked by other diseases, the symptoms are very characteristic of rheumatoid disease. Rheumatoid arthritis symptoms and signs include the following:

Rheumatoid arthritis usually (not always) involves many joints on both sides of the body. It is, therefore, sometimes referred to as a symmetric polyarticular form of arthritis. Accordingly, the small joints of the hands, wrists, and feet are commonly affected. The knees, ankles, shoulders, hips, and elbows can also be involved in early disease. Rheumatoid arthritis is characterized by inflammation in these joints. Early manifestations of this inflammation can be gradual or rapidly intense. The joint inflammation causes stiffness, usually worse in the morning or after being sedentary. It also causes warmth, swelling, redness, and pain in varying degrees. The joint can be very subtly affected with slight swelling or markedly affected with substantial loss of range of motion. The pain level can be completely disabling and does not always correlate with the degree of apparent inflammation.

As described above, the manner that each of the symptoms affects an individual can be very different from individual to individual and can vary during the day. The intensity and effect of each of the symptoms is dependent upon the patient's age, activity, the medications he or she takes, as well as any additional medical conditions that are present.

What are the less common forms of rheumatoid arthritis?

Rheumatoid arthritis can begin in less common forms. For example, it can begin with involvement of only a single joint or a few joints. Sometimes, this can later evolve to the more common presentation of many joints on both sides of the body. Rarely, the earliest symptom of rheumatoid disease is inflammation of a body area that does not even involve a joint. For example, the lining of the lungs (pleura) can become inflamed to cause pleurisy many months before the arthritis develops. Occasionally, only a few joints are involved and the doctor may suspect another type of inflammatory arthritis. (There are over 100 forms of arthritis!) Again, this can sometimes only later evolve to become the more typical symmetrical polyarthritis by including many joints on both sides of the body.

The caveat is that by recognizing early symptoms of rheumatoid arthritis doctors can address the disease early, thereby affording optimal outcomes for those affected.

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REFERENCE: MedscapeReference.com. Rheumatoid Arthritis Clinical Presentation.

Last Editorial Review: 7/3/2014