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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), 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 malaise, fatigue, fever, loss of appetite, weight loss, muscle aches, and weakness.

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 3/11/2019

Rheumatoid Arthritis (RA) Symptoms

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

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 tobacco smoking, silica exposure, and periodontal (gum) disease.

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) Exercises Joint-Friendly Fitness Routines Slideshow

Rheumatoid Arthritis (RA) Exercises  Joint-Friendly Fitness Routines Slideshow

Rheumatoid arthritis is the most common form of autoimmune arthritis. It causes joints to become

  • painful,
  • tender,
  • swollen, and
  • stiff.

People with rheumatoid arthritis (RA) often have more than one joint affected by the condition. The same two joints on opposite sides of the body are frequently involved with RA. RA impacts small joints, which are found in the

  • wrists,
  • hands, and
  • feet.

Although joint problems are the first things people recognize when it comes to arthritis, the disease of rheumatoid arthritis can impact other parts of the body as well. With RA,

  • eyes become dry, painful, and red,
  • the mouth becomes dry and gums are more easily irritated or infected,
  • the skin can develop small lumps over bony areas known as rheumatoid nodules,
  • blood vessels become inflamed, potentially causing nerve and skin damage,
  • the number of red blood cells can drop, called anemia, and
  • lungs can become inflamed and scarred, causing shortness of breath.


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