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A Doctor's View on 15 Early Symptoms and Signs of Rheumatoid Arthritis (RA)

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

Early RA symptoms and signs vary differently from person to person. The most common body parts that are initially affected by RA include the small joints of the hands, wrists, and feet, and the knees and hip joints. Joint inflammation causes stiffness. Warmth, redness, and pain may vary in degree. Read the entire Doctor's View

What are rheumatoid arthritis symptoms and signs?

RA symptoms come and go, depending on the degree of tissue inflammation. When body tissues are inflamed, the disease is active. When tissue inflammation subsides, the disease is inactive (in remission). Remissions can occur spontaneously or with treatment and can last weeks, months, or years. During remissions, symptoms of the disease disappear, and people generally feel well. When the disease becomes active again (relapse), symptoms return. The return of disease activity and symptoms is called a flare. The course of rheumatoid arthritis varies among affected individuals, and periods of flares and remissions are typical.

What does rheumatoid arthritis feel like?

When the disease is active, RA symptoms can include

  • fatigue,
  • loss of energy,
  • lack of appetite,
  • low-grade fever,
  • muscle and joint aches, and
  • stiffness.

Muscle and joint stiffness are usually most notable in the morning and after periods of inactivity. This is referred to as morning stiffness and post-sedentary stiffness. Arthritis is common during disease flares. Also during flares, joints frequently become warm, red, swollen, painful, and tender. This occurs because the lining tissue of the joint (synovium) becomes inflamed, resulting in the production of excessive joint fluid (synovial fluid). The synovium also thickens with inflammation (synovitis).

Rheumatoid arthritis usually inflames multiple joints and affects both sides of the body. In its most common form, therefore, it is referred to as a symmetric polyarthritis. Early RA symptoms may be subtle. The small joints of both the hands and wrists are often involved. Early symptoms of rheumatoid arthritis can be pain and prolonged stiffness of joints, particularly in the morning. Symptoms in the hands with rheumatoid arthritis include difficulty with simple tasks of daily living, such as turning door knobs and opening jars. The small joints of the feet are also commonly involved, which can lead to painful walking, especially in the morning after arising from bed. Occasionally, only one joint is inflamed. When only one joint is involved, the arthritis can mimic the joint inflammation caused by other forms of arthritis, such as gout or joint infection. Chronic inflammation can cause damage to body tissues, including cartilage and bone. This leads to a loss of cartilage and erosion and weakness of the bones as well as the muscles, resulting in joint deformity, loss of range of motion, destruction, and loss of function. Rarely, rheumatoid arthritis can even affect the joint that is responsible for the tightening of our vocal cords to change the tone of our voice, the cricoarytenoid joint. When this joint is inflamed, it can cause hoarseness of the voice. Symptoms in children with rheumatoid arthritis include limping, irritability, crying, and poor appetite.

Picture of rheuamtoid arthritis joint deformity in the feet
Picture of rheumatoid arthritis joint deformity in the feet; Image provided by Getty Images
Return to Rheumatoid Arthritis (RA)

See what others are saying

Comment from: Bobby T., 45-54 Male (Patient) Published: October 27

I have been dealing with rheumatoid arthritis for my whole life, it started about in my early 30s back in the 90s. I would have my hand swell up to big red balloons around my knuckles and I wouldn't be able to move the hands at all. What I did notice that helped relieve the pain, but not the swelling was Absorbine Jr. The arthritis cream made it easier with the stiffness and the pain when I had the worst conditions. The swelling and the movement were still bad though and sometimes that made it hard to do the easiest of tasks around the house. The thing I noticed at first and the early signs were pain and the swelling. The swelling where my knuckles would get red where the first indications that I had rheumatoid arthritis. I hope this helps your cause.

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Comment from: lhammer, 35-44 Female (Patient) Published: August 16

My symptoms of rheumatoid arthritis (RA) began last spring. My left wrist and fingers became swollen and red. I am a special education teacher of students with moderate to severe disabilities, and one of my students was extremely aggressive: hitting, kicking and scratching my instructional assistants and me. I assumed it was a result of attempting to calm her down when she was a danger to herself, her teachers, and her classmates. The pain and swelling lasted several days, and went away as quickly as it had appeared. Two weeks later I had the same experience with my right hand, and had me convinced I had broken my wrist. Again, the pain and swelling subsided after several days. Last week I woke up fine, then began to feel pain in my shoulder and elbow so badly that I had to hold one arm up with the other to keep it from hanging at my side. All that I remembered was that I had thrown a ball with my son at the pool and had watered the flowers. I already had my yearly physical with my primary care physician scheduled, and mentioned the issues I was having. She did some bloodwork and had me get my arm x-rayed. I didn't think much more about it. This morning my doctor called and told me my CCP level was high (134), indicating I have RA, and referred me to a rheumatologist. The information is just starting to sink in. My husband has fibromyalgia, so I'm the primary caretaker of our children (ages 5 and 16) and wonder what will happen when my RA gets worse. I'm also worried about my ability to do my job. I'm only 42, so I have a long time to go before I can retire.

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Comment from: tinker sad, 55-64 Female (Patient) Published: June 21

I had my head in the sand, in denial for about a year! We live out in the country so at first I thought I had been bit by a spider. I would rest for a bit and ice the hands/feet and then it would stop, until recently. Now if I lift a suitcase, make up bag or anything my hands/fingers swell way up, turn deep red, and the only thing that helps is plunging my feet in a bath of ice water. Taking Benadryl and NSAIDs did not help. I found a new doctor and she pushed me to do all this bloodwork after I took pictures on my cell phone of my fingers. I have rheumatoid arthritis and it is scary! I am a caretaker for my husband and our farm, and well, it is going to be a big adjustment. I was put on a pain medicine that also helps with the swelling. My guess is I will end up on methotrexate or prednisone. Good luck each and every one of you, this disease is a learning process. Don't give up.

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