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Symptoms and Signs of Rheumatoid Arthritis (RA)

Doctor's Notes on Rheumatoid Arthritis (RA)

Rheumatoid arthritis (also termed RA) is a chronic joint disease that also potentially affects internal organs of the body. No matter what organ may be affected by RA, the joints are always affected and may have one or more of the following signs and symptoms:

  • stiffness,
  • inflammation (tender, red, and warm joints that can be swollen),
  • loss of joint range of motion,
  • limping
  • polyarthritis
  • symmetric
  • nodule formation (red bumps that are hard that are found near the joints) and
  • pain in the joints.
  • As the disease progresses, joint function decreases.

General symptoms usually come on gradually and may include

The causes of rheumatoid arthritis are not known. However, most researchers consider abnormal activity of the body's immune system as major cause of this disease. However, risk factors considered by experts include

  • genetics,
  • hormones,
  • possible infections by bacteria and/or viruses
  • tobacco smoking,
  • silica exposure and 
  • gum disease as possible triggers for this disease.
  • It is theorized that altered levels of gut bacteria may also play a role in rheumatoid arthritis development.

These risk factors that occur in other organs can precede RA development.

Medical Author:
Medically Reviewed on 7/19/2019

Rheumatoid Arthritis (RA) Symptoms

  • Musculoskeletal structures: Damage to muscles surrounding joints may cause atrophy (shrinking) that results in weakness. This is most common in the hands. Atrophy also may result from not using a muscle, such as from pain or swelling. Damage to bones and tendons can cause deformities, especially of the hands and feet. Osteoporosis and carpal tunnel syndrome are other common complications of rheumatoid arthritis.
  • Skin: Many people with rheumatoid arthritis develop small, firm nodules on or near the joint that are visible under the skin. These are known as rheumatoid nodules and are most noticeable under the skin on the bony areas that stick out when a joint is flexed. Dark purplish areas on the skin (purpura) are caused by bleeding into the skin from weakened blood vessels. Purpura is particularly common in those patients who have taken cortisone medication, such as prednisone.
  • Heart: A collection of fluid around the heart (pericardial effusion) from inflammation is not uncommon in rheumatoid arthritis. This usually causes only mild symptoms, if any, but it can be very severe and lead to poor heart function. Rheumatoid arthritis-related inflammation can affect the heart muscle, the heart valves, or the blood vessels of the heart (coronary arteries). Heart attacks are more frequent in patients with rheumatoid arthritis than those without it, therefore, monitoring cholesterol and cardiovascular health is important.
  • Lungs: Rheumatoid arthritis' effects on the lungs may take several forms. Fluid may collect around one or both lungs and is referred to as a pleural effusion. Inflammation of the lining tissues of the lungs is known as pleuritis. Less frequently, lung tissues may become stiff or scarred, referred to as pulmonary fibrosis. Any of these effects can have a negative effect on breathing. Lung infections are more common with rheumatoid arthritis. Rheumatoid nodules of local inflammation can occur in the lungs.
  • Digestive tract: The digestive tract is usually not affected directly by rheumatoid arthritis. Dry mouth, related to Sjögren's syndrome, is the most common symptom of gastrointestinal involvement. Digestive complications are much more likely to be caused by medications used to treat the condition, such as gastritis (stomach inflammation) or stomach ulcer caused by NSAID therapy.
  • Kidneys: The kidneys are not usually affected directly by rheumatoid arthritis. Kidney problems in rheumatoid arthritis are much more likely to be caused by medications used to treat the condition. Nevertheless, severe, long-standing disease can uncommonly lead to a form of protein deposition and damage to the kidney, referred to as amyloidosis.
  • Blood vessels: Inflammation of the blood vessels can cause problems in any organ but is most common in the skin, where it appears as purple patches (purpura) or skin ulcers.
  • Blood: Anemia or "low blood" is a common complication of rheumatoid arthritis. Anemia means that there is an abnormally low number of red blood cells and that these cells are low in hemoglobin, the substance that carries oxygen through the body. (Anemia has many different causes and is by no means unique to rheumatoid arthritis.) A low white blood cell count (leukopenia) can occur from Felty's syndrome, a complication of rheumatoid arthritis that is also characterized by enlargement of the spleen.
  • Nervous system: The deformity and damage to joints in rheumatoid arthritis often lead to entrapment of nerves. Carpal tunnel syndrome is one example of this. Entrapment can damage nerves and may lead to serious consequences.
  • Eyes: The eyes commonly become dry and/or inflamed in rheumatoid arthritis. This is a result of inflammation of the tear glands and is called Sjögren's syndrome. The severity of this condition depends on which parts of the eye are affected. There are many other eye complications of rheumatoid arthritis, including inflammation of the whites of the eyes (scleritis), which often require the care of an ophthalmologist.

Like many autoimmune diseases, rheumatoid arthritis typically waxes and wanes. Most people with rheumatoid arthritis experience periods when their symptoms worsen (known a flare-up or active disease) separated by periods in which the symptoms improve. With successful treatment, symptoms may even go away completely (remission, or inactive disease).

Although rheumatoid arthritis can have many different symptoms, joints are always affected. Rheumatoid arthritis almost always affects the joints of the hands (such as the knuckle joints), wrists, elbows, knees, ankles, and/or feet. The larger joints, such as the shoulders, hips, and jaw, may be affected. The vertebrae of the neck are sometimes involved in people who have had the disease for many years. Usually at least two or three different joints are involved on both sides of the body, often in a symmetrical (mirror image) pattern. The usual joint symptoms include the following:

  • Stiffness: The joint does not move as well as it once did. Its range of motion (the extent to which the appendage of the joint, such as the arm, leg, or finger, can move in different directions) may be reduced. Typically, stiffness is most noticeable in the morning and improves later in the day.
  • Inflammation: Red, tender, and warm joints are the hallmarks of inflammation. Many joints are typically inflamed (polyarthritis).
  • Swelling: The area around the affected joint is swollen and puffy.
  • Nodules: These are hard bumps that appear on or near the joint. They often are found near the elbows. They are most noticeable on the part of the joint that juts out when the joint is flexed.
  • Pain: Pain in rheumatoid arthritis has several sources. Pain can come from inflammation or swelling of the joint and surrounding tissues or from working the joint too hard. The intensity of the pain varies among individuals.

These symptoms may keep someone from being able to carry out normal activities. General symptoms include the following:

  • Malaise (a "blah" feeling)
  • Fever
  • Fatigue
  • Loss of appetite or lack of appetite
  • Weight loss
  • Myalgias (muscle aches)
  • Weakness or loss of energy

The symptoms usually come on very gradually, although in some people they come on very suddenly. Sometimes, the general symptoms come before the joint symptoms, and an individual may think he or she has the flu or a similar illness.

The following conditions suggest that rheumatoid arthritis is quiet, referred to as "in remission":

  • Morning stiffness lasting less than 15 minutes
  • No fatigue
  • No joint pain
  • No joint tenderness or pain with motion
  • No soft-tissue swelling

  • The usual symptoms of rheumatoid arthritis are stiff and painful joints, muscle pain, and fatigue.
  • The experience of rheumatoid arthritis is different for each person.
  • Some people have more severe pain than others.
  • Most people with rheumatoid arthritis feel very stiff and achy in their joints, and frequently in their entire bodies, when they wake up in the morning.
  • Joints may be swollen, and fatigue is very common.
  • It is frequently difficult to perform daily activities that require use of the hands, such as opening a door or tying one's shoes.
  • Since fatigue is a common symptom of rheumatoid arthritis, it is important for people with rheumatoid arthritis to rest when necessary and get a good night's sleep.
  • Systemic inflammation is very draining for the body.
  • The usual symptoms of rheumatoid arthritis are stiff and painful joints, muscle pain, and fatigue.
  • The experience of rheumatoid arthritis is different for each person.
  • Some people have more severe pain than others.
  • Most people with rheumatoid arthritis feel very stiff and achy in their joints, and frequently in their entire bodies, when they wake up in the morning.
  • Joints may be swollen, and fatigue is very common.
  • It is frequently difficult to perform daily activities that require use of the hands, such as opening a door or tying one's shoes.
  • Since fatigue is a common symptom of rheumatoid arthritis, it is important for people with rheumatoid arthritis to rest when necessary and get a good night's sleep.
  • Systemic inflammation is very draining for the body.

Rheumatoid Arthritis (RA) Causes

The cause of rheumatoid arthritis is not known. Many risk factors are involved in the abnormal activity of the immune system that characterizes rheumatoid arthritis. These risk factors include

  • genetics (inherited genes),
  • hormones (explaining why the disease is more common in women than men), and
  • possibly infection by a bacterium or virus.

Other environmental factors known to increase the risk for developing rheumatoid arthritis include

Medical scientists have shown that alterations in the microbiome (altered levels of gut bacteria that normally inhabit the bowels) exist in people with rheumatoid arthritis. Emerging research shows that the microbiome has an enormous influence on our health, immune system, and many diseases, even those previously not directly linked to the gastrointestinal tract. Studies have shown different kinds of bacteria in the intestines of people with rheumatoid arthritis than in those who do not have rheumatoid arthritis. However, it remains unknown how this information can be used to treat rheumatoid arthritis. Treatment is probably not as simple as replacing missing bacteria, but this may explain why some individuals with rheumatoid arthritis feel better with various dietary modifications.

Rheumatoid Arthritis (RA) Symptoms & Treatment Slideshow

Rheumatoid Arthritis (RA) Symptoms & Treatment Slideshow

Rheumatoid arthritis (RA) is an autoimmune disease where the body attacks the lining tissue of joints, causing chronic joint inflammation. While it primarily affects joints, it can also cause inflammation of organs, such as the lungs, eyes, skin, and heart.

People with RA may experience an increase in symptoms –called flares – that can last for days or weeks. They may also have periods of remission where they have few or no symptoms. There is no cure for rheumatoid arthritis, but medications can stop the progression of the disease and ease symptoms.

REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

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