What Is the Significance of Joint Pain, Swelling, Stiffness, Warmth, Limping, and Loss of Range of Motion?
Medical Author: William C. Shiel Jr., MD, FACP, FACR
Medical Editor: Catherine Burt Driver, MD
Every patient with rheumatoid arthritis has encountered joint symptoms. Doctors recognize that each symptom varies in location, intensity, and duration from patient to patient as well as at different times of day. But what do these symptoms suggest to the doctor? What can they mean for the patient? Why are they important, not only for initial diagnosis, but in monitoring the rheumatoid disease while on treatment?
Rheumatoid arthritis is a classic chronic disease that is characterized by inflammation in joints that can lead to permanent damage. Because it is chronic, optimal monitoring of the disease is mandatory in order to minimize its potentially damaging consequences. A major part of monitoring requires recognizing key symptoms that can indicate ongoing inflammation.
Joint pain and swelling can come from a variety of common causes that are not from inflammation. We recognize these as joint injuries, such as sprains or bruises, as well as wear and tear injuries of cartilage. In distinguishing the joint pain of rheumatoid arthritis from these non-inflammatory conditions, we search for other symptoms of inflammation and notice that many joints are being affected as opposed to single joints, such as from injury.
Classic indicators of inflammation of joints include not only pain and swelling but also warmth and redness. Each of these symptoms can indicate ongoing inflammation of the involved joints and will be taken into account by the treating health care professional when suggesting or monitoring treatments. As doctors, in fact, we commonly use the amount of stiffness in the morning as a crude measure of how much inflammation is present.
When rheumatoid arthritis causes limping, it is typically a result of ongoing inflammation or permanent damage to joints such as the knees, ankles, hips, or joints of the feet. The doctor will want to know if a patient with rheumatoid arthritis has developed limping because this information will point him/her to consider whether or not there is active inflammation in or permanent damage to any of these joints, or if there is another cause of the limping, such as a nerve or muscle condition.
Loss of range of motion of a joint can have several possible causes in a patient with rheumatoid arthritis. With ongoing, active inflammation of a joint, the joint can swell to impair full range of motion. As a result of longstanding joint inflammation, the cartilage, bone, and ligaments can be damaged so that full range of motion is no longer possible. Long-standing inflammation of the joint can lead to scarring around the joint as well as atrophy of the muscles responsible for moving the joint, both of which can limit the range of motion.
Ultimately, each symptom is important in assessing the status of the rheumatoid condition. For the best outcome, the symptoms patients have are reviewed with the health care professional, as together they help in making the best treatment choices.
Klippel, John H., et al., eds. Primer on the Rheumatic Diseases. 13th ed. New York: Springer and Arthritis Foundation, 2008.