Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. Unlike osteoarthritis, which results from wear and tear on joint cartilage, RA is an inflammatory condition that affects the lining of the joints (synovium). In RA, the immune system mistakenly attacks the joints and other body parts, causing inflammation that can damage the joint tissue.
The most common early symptoms of RA include joint pain, swelling, and stiffness that lasts for more than 6 weeks. The small joints of the hands and feet are usually affected first, such as the knuckles and the middle joints of the fingers. RA can also affect the wrists, elbows, knees, ankles, neck, jaw, and hips. The joint symptoms are typically symmetrical, meaning they impact both sides of the body equally.
In the early stages, RA joint pain may feel like a dull ache or stiffness. Many people describe the pain as a burning sensation. The affected joints may feel warm to the touch. Joint stiffness is usually most noticeable first thing in the morning or after long periods of inactivity. This early morning stiffness typically lasts for at least one hour before improving.
Joint Pain and Swelling
The hallmark symptoms of early rheumatoid arthritis are joint pain, swelling, and tenderness. These symptoms are due to inflammation of the synovial membrane that lines and lubricates the joints. In a healthy joint, the synovial membrane secretes fluid that nourishes the cartilage and lubricates joint movement.
In RA, inflammatory chemicals are released that cause the synovium to thicken and accumulate fluid. This leads to swelling, redness, warmth, and joint pain. The swelling caused by synovial inflammation is called synovitis. It can cause the joints to become enlarged, tender, and stiff.
The small joints of the hands and feet are usually the first to be affected by rheumatoid arthritis. Some of the commonly affected joints include:
– Knuckles (metacarpophalangeal joints)
– Middle joints of the fingers (proximal interphalangeal joints)
– Base of the fingers (metacarpophalangeal joints)
– Wrists
– Ball of the foot (metatarsophalangeal joints)
– Joints between toe bones (interphalangeal joints)
In the hands, swelling and tenderness may cause the joints to take on a spindle shape. Rheumatoid arthritis can also affect the tendons, causing bumps or nodules under the skin.
Joint Pain Pattern
The joint pain caused by RA tends to affect both sides of the body equally. This is known as a symmetric pattern. For example, pain, swelling, and stiffness will likely occur in the same joints on both hands or both feet. The corresponding joints on opposite sides of the body are involved.
This symmetrical pattern helps distinguish rheumatoid arthritis from other types of arthritis. Osteoarthritis, for example, often affects just one joint or one side of the body initially.
Pain Quality
In the early stages of RA, joint pain may be described as:
– Aching
– Throbbing
– Tender
– Stiff
– Burning
– Shooting pain
– Muscle tightness or soreness
Many people report joint stiffness and achiness that is worse in the morning. The morning stiffness typically lasts more than one hour but improves with movement and activity. The joint pain may feel worse after periods of inactivity or toward the end of the day.
RA joint pain can range from mild to severe. During RA flares, the joint pain may become sharp and intense. Even light touch can make the affected joints hurt more.
Other Early Symptoms
Along with joint pain and swelling, rheumatoid arthritis can cause a variety of other symptoms, even in the early stages. These include:
Fatigue and Weakness
The inflammation caused by RA leads to persistent fatigue and weakness. People with RA often notice a lack of energy and may feel extremely tired even after mild activity or exercise. The chronic widespread inflammation induces fatigue through several mechanisms including impaired sleep, anemia (low red blood cell counts), muscle loss, and abnormal immune signaling.
Fever and Ill Feeling
A low-grade fever may accompany RA flares early on. The body mounts an immune response against the joints that causes a slight increase in temperature. People with RA flares often report “just not feeling well” – a sense of body aches, chills, and malaise. However, high fevers are uncommon unless infection is also present.
Appetite Loss
The powerful immune and inflammatory response of RA can suppress normal appetite. People with RA may experience loss of appetite and unintentional weight loss, especially during flare-ups.
Numbness and Tingling
Inflammation of the joints can compress nerves, resulting in numbness, tingling, or burning pain in the hands and feet. Carpal tunnel syndrome involving numbness or tingling in the hands is common with RA. Nodules under the skin (rheumatoid nodules) can also cause nerve compression.
Dry Mouth and Eyes
RA is an inflammatory disease that can reduce tear and saliva production, leading to dry eyes and dry mouth. Sjogren’s syndrome, an autoimmune condition causing moisture-deficient eyes and mouth, commonly co-occurs with RA.
When to See a Doctor
See your doctor promptly if you experience persistent joint pain, swelling, and stiffness – especially in multiple matching joints. Morning joint stiffness lasting over one hour also warrants medical evaluation. While joint symptoms can mimic other types of arthritis initially, getting an accurate diagnosis quickly is crucial.
Rheumatoid arthritis causes progressive joint damage over time, so early diagnosis and treatment provides the best opportunity to control inflammation and halt progression. Certain blood tests and imaging scans can confirm the diagnosis. Treatment is aimed at minimizing joint damage. Disease-modifying anti-rheumatic drugs (DMARDs) and biologics that suppress the immune system are often prescribed.
Don’t write off unexplained joint pain as “normal aches and pains.” The distinctive pattern of RA joint involvement provides clues to the diagnosis. Pay attention to which joints are affected, the symmetry, and any accompanying symptoms. Keep track of when joint problems occur, what makes them better or worse, and how symptoms evolve over time. These details can help your doctor determine if rheumatoid arthritis is a possibility.
Conclusion
In the early stages, rheumatoid arthritis commonly causes joint pain, swelling, and stiffness – particularly in the small joints of the hands and feet. The joint involvement is usually symmetrical, impacting both sides of the body equally. People with RA often describe joint pain as a dull, aching pain with sensations of warmth and tenderness in the affected areas.
Morning stiffness lasting over an hour is characteristic of early RA. Other common symptoms include fatigue, malaise, decreased appetite, numbness and tingling, and dry eyes and mouth. While joint pain can initially mimic other types of arthritis, the pattern of joint involvement, symmetry of symptoms, and other systemic symptoms are hallmarks of rheumatoid arthritis. Seeing a doctor promptly for evaluation and diagnosis is key.