Early in the disease, people with rheumatoid arthritis may lose their appetite and feel sore, stiff, achy and generally fatigued. These vague musculoskeletal symptoms may persist for weeks to months before more specific symptoms develop in the joints. Pain, tenderness and swelling usually affect multiple joints in a symmetric pattern on both sides of the body, although joint swelling may not be evident in early stages. In a small percentage of people, rheumatoid arthritis occurs suddenly, and symptoms develop abruptly in multiple joints.
The most commonly affected joints include the small joints of the hands, wrists, feet and ankles. It is not rare, however, also to have symptoms in other joints, such as the elbows, shoulders, knees and hips. Inflammation of the neck joints (cervical spine) and jaw joint (temporomandibular joint, or TMJ) is also common. The joints on both right and left sides of the body are usually affected equally, so symptoms are distributed symmetrically.
Typical joint symptoms include:
- Tightness or stiffness
- Limited motion
Joint pain is usually described as a dull ache, similar to a toothache or headache, although how a person perceives chronic pain is highly variable. The inflamed joints may be warm to the touch and visibly swollen. Swelling is associated with the accumulation of joint fluid in the joint and thickened tissue. It may cause tightness or stiffness and may limit joint motion. These symptoms are generally worse in the morning and get better with use; in fact, morning stiffness is a typical feature of rheumatoid arthritis.
Joint deformity. Over time, joints affected by rheumatoid arthritis may be visibly deformed and may not function properly. Inflammation of the synovium (the cells that line the joint) leads to cartilage destruction and damage to the bone, ligaments and tendons. In addition to deformity, this process leads to joint loosening, diminished strength and loss of movement. Surgery may be needed to correct or repair these problems (see Take Action ). It is important to recognize that although rheumatoid arthritis is known for its potential to destroy joints, this does not occur in every patient. Some patients have only mild joint inflammation, and many never develop deformities.
Weakness and loss of joint movement. When joint pain or poor function affects movement, muscles near the affected joint may become small and weak because of disuse. This may lead to even more difficulty with movement.
- General symptoms, such as malaise and fatigue
- Rheumatoid nodules
- Rheumatoid vasculitis
- Neurological symptoms
- Inflammation of other areas
General symptoms. General symptoms of rheumatoid arthritis — referred to by health-care providers as "constitutional," or body-wide, symptoms — include:
- Weight loss
- Low-grade fever
Generalized malaise and fatigue are common complaints of people with rheumatoid arthritis. Sometimes, the fatigue occurs late in the day and requires a nap. Some people experience a loss of appetite, which may result in weight loss. Occasionally, rheumatoid arthritis is accompanied by a mild fever. But with any fever, especially moderate to high fevers, an infection or other cause must be considered.
Rheumatoid nodules. Inflammatory nodules, called rheumatoid nodules, occur in up to 20 percent to 30 percent of people with rheumatoid arthritis. These firm, moveable nodules the size of a pea, acorn or walnut may develop just beneath the skin near the elbow and other areas subjected to pressure. Other common locations include the Achilles tendon, fingers and toes. But rheumatoid nodules may occur anywhere, including the lungs. Rheumatoid nodules are uncommon early in the disease. But if they appear, they may disappear spontaneously. Sometimes, drug treatment with methotrexate is associated with enlarged or new nodules.
Rheumatoid vasculitis. Vasculitis is inflammation of the blood vessels. This condition is often associated with severe rheumatoid arthritis and other autoimmune diseases. In rheumatoid vasculitis, the tissues supplied by the inflamed blood vessels may become deprived of blood and damaged or destroyed as a consequence. Blood vessels of the skin, nerves and kidney are most commonly involved.
Neurological symptoms. Rheumatoid arthritis does not affect the nervous system directly. Rather, neurological symptoms (those that affect the nervous system) may result for other reasons:
- Neurological symptoms may occur when joint deformity affects the nerves of the arms or legs that travel near the affected joint.
- Neurological symptoms also may occur when damaged joints in the neck cause compression of the spinal cord. The most prominent symptom is numbness or tingling in the extremities. Sometimes these changes can cause weakness or even loss of function in one area. For example, you may be unable to raise your wrist.
- Neurological symptoms may occur as the result of vasculitis because blood vessels that supply nerves become inflamed.
Inflammation of other areas. Although rheumatoid arthritis is characterized by inflammation of the joints, tissues outside the joints also may become inflamed. Such inflammation usually goes unnoticed, but it may cause symptoms when it affects the membranes surrounding the heart, leading to pericarditis, or the lungs, leading to breathlessness. Rheumatoid arthritis also may involve the eye in a few people with long-standing disease. This may cause eye pain or redness.
The inflammation characteristic of rheumatoid arthritis also can lead to other potential problems, including enlargement of the spleen or lymph nodes and anemia (a low red blood cell count). Some people develop Felty's syndrome, in which severe arthritis is accompanied by an enlarged spleen and a low white blood cell count. Finally, people with rheumatoid arthritis sometimes notice hoarseness, especially in the morning, caused by inflammation of joints in the neck.
Depression. Rheumatoid arthritis may worsen pre-existing depression. Or people may develop depression while attempting to cope with their discomfort and the realities of chronic disease. Rheumatoid arthritis patients who are depressed may benefit from psychological counseling, education, support groups or drug treatment.