Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation and pain in the joints. The most common symptoms of rheumatoid arthritis are joint pain, swelling, stiffness, and loss of joint function. But what does rheumatoid arthritis pain actually feel like? Here is an overview of the common sensations and descriptions of rheumatoid arthritis pain.
Joint Pain
The most common rheumatoid arthritis symptom is joint pain. This pain can range from mild to severe. Many describe rheumatoid arthritis joint pain as:
- Aching
- Throbbing
- Shooting
- Stabbing
- Tiring
- Nagging
- Unrelenting
- Intense
- Burning
- Stiff
The joint pain may start gradually over weeks or months. It often affects both sides of the body simultaneously, such as in both wrists or both knees. The wrists, fingers, knees, feet, and ankles are most commonly affected, but pain can occur in any joint.
Joint Swelling
Joint swelling (synovitis) frequently accompanies rheumatoid joint pain. The synovial membrane, which lines and lubricates the joints, becomes inflamed and swollen. This leads to fluid accumulation and joint swelling. The swelling can cause the joint to appear larger or deformed. It may make moving the joint difficult and painful.
Joint Stiffness
Joint stiffness is another hallmark rheumatoid arthritis symptom. The inflammation makes the joints feel stiff, especially first thing in the morning or after long periods of inactivity. Many describe rheumatoid joint stiffness as feeling like the joints need oil or are rusted in place. It can take a while to fully limber up stiff joints when getting out of bed in the morning or after sitting for long periods.
Joint Instability
As rheumatoid arthritis progresses, it can damage the ligaments, tendons, and cartilage in the joints. This leads to looseness or instability in the joints. The description of instability varies based on the joint. In the fingers, instability makes them feel loose and weak during grasping activities. In the knees, it can feel like the knee may give out or buckle. In the shoulders, it leads to a painful slipping sensation. Joint instability indicates advancing joint damage.
Loss of Range of Motion
The combination of joint swelling, pain, and stiffness leads to a decreased range of motion in the joints. Simple movements like fully straightening the fingers or arms become difficult or impossible. Loss of joint flexibility is common and can significantly impact daily activities and quality of life.
Bone Pain
Some with rheumatoid arthritis experience pain directly in the bones around affected joints. This occurs because the inflamed synovium releases chemicals that damage and thin the adjacent bones. Bone pain may feel like a deep, dull, aching pain. It is often worse at night or when bearing weight on the joint.
Fatigue
Debilitating fatigue affects over 90% of those with rheumatoid arthritis. It is often one of the most disruptive symptoms of the disease. The fatigue is described as an overwhelming feeling of tiredness, exhaustion, and lack of energy. It is not relieved by rest and often described as “more than just being tired.” The cause is multifactorial – involving inflammation, pain, poor sleep, anemia, and depression.
When Does Pain and Stiffness Worsen?
Rheumatoid arthritis symptoms tend to follow a daily pattern of good and bad periods. Symptoms are usually worst first thing in the morning. Morning stiffness in the joints can last over an hour after waking. Pain and stiffness then often improve throughout the day, only to worsen again in the evening after activity.
Symptoms also commonly flare with cold, damp weather or after long periods of inactivity. Stress, illness, and over-activity can also worsen rheumatoid arthritis pain.
Which Joints are Most Commonly Affected?
| Joint | Frequency of Involvement |
|---|---|
| Hands and wrists | 85% |
| Knees | 80% |
| Feet | 80% |
| Elbows | 65% |
| Shoulders | 50% |
| Hips | 50% |
| Cervical spine | 40% |
| Jaw | 25% |
The joint involvement pattern is usually symmetric – affecting both sides of the body equally. The small joints of the hands and feet are often affected early in the disease.
How is Rheumatoid Arthritis Pain Diagnosed?
There is no single test that can definitively diagnose rheumatoid arthritis. A rheumatologist will take a full medical history and conduct a physical exam to check for joint swelling, tenderness, deformities, and limited mobility. They will also order blood tests to check for:
- Rheumatoid factor – an antibody found in most RA patients
- Anti-CCP antibodies – highly specific for rheumatoid arthritis
- ESR and CRP tests – measure inflammation levels
- Complete blood count – checks for anemia
Imaging such as x-rays, ultrasound, or MRI are sometimes used to confirm joint damage. The diagnostic process aims to rule out other potential causes of joint pain like osteoarthritis, gout, or joint infections.
How Can Rheumatoid Arthritis Pain be Treated?
While there is no cure for rheumatoid arthritis, many effective treatments are available to manage pain, reduce joint damage, and improve quality of life. Treatment typically involves a combination of medications, physical therapy, joint protection, and self-management strategies. Key medication options include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) – reduce inflammation and pain
- Corticosteroids – quickly reduce swelling and pain
- Disease-modifying antirheumatic drugs (DMARDs) – slow disease progression
- Biologic agents – target specific parts of the immune system
- JAK inhibitors – block inflammation signaling in cells
The goals of treatment are to control symptoms, prevent joint damage, and achieve remission. With newer treatment options, remission is possible for many rheumatoid arthritis patients.
Lifestyle Changes and Self-management
Certain lifestyle measures can help complement medical treatment:
- Exercise improves joint mobility and strength
- Joint protection techniques reduce strain on sore joints
- Assistive devices like splints, braces, or canes take pressure off joints
- Heat and cold therapies temporarily relieve pain
- Relaxation techniques help manage pain and stress
- Weight control takes load off weight-bearing joints
Learning arthritis self-management skills helps patients take an active role in controlling their symptoms.
What is the Prognosis for Rheumatoid Arthritis?
In the past, rheumatoid arthritis led to severe crippling of the joints. Modern treatments have greatly improved the prognosis. Most patients achieve some degree of disease control with early, aggressive therapy. While joint damage can occur, it is generally less severe than in the past.
About one-third of RA patients achieve eventual remission – either through medication or spontaneously. Another third experience only mild or moderate symptoms that do not interfere greatly with daily activities. The final third have more aggressive, treatment-resistant disease with higher levels of pain and disability.
Conclusion
Rheumatoid arthritis causes joint inflammation and damage that results in pain, swelling, stiffness, and loss of joint function. The pain is often described as aching, throbbing, or shooting in nature. It follows a daily pattern of morning stiffness and evening worsening. Fatigue is also a dominant complaint.
While incurable, current treatments can effectively control symptoms, slow joint damage, and improve quality of life. Lifestyle measures and self-management skills also help patients minimize rheumatoid arthritis pain and flares.