Symptoms

The hallmark symptom of rheumatoid arthritis is morning stiffness that lasts for at least an hour. (Stiffness from osteoarthritis, in contrast, usually clears up within half an hour.) Even after remaining motionless for a few moments, the body can stiffen. Movement becomes easier again after loosening up.

Most typically, the onset of symptoms takes place over the course of weeks or even months. However, rapid onset with more severe symptoms may also occur.

Swelling and Pain

Swelling and pain in the joints must occur for at least 6 weeks before a diagnosis of rheumatoid arthritis is considered. The inflamed joints are usually swollen and often feel warm and "boggy" (spongy) when touched. The pain often occurs on both sides of the body (symmetrically) but may be more severe on one side of the body, depending on which hand the person uses more often.

Specific Joints Affected

Although rheumatoid arthritis almost always develops in the wrists and knuckles, the knees and joints of the ball of the foot are often affected as well. Many joints may eventually be involved, including those in the cervical spine, shoulders, elbows, tips, temporomandibular joint (jaw), and even joints between very small bones in the inner ear. Rheumatoid arthritis does not usually show up in the fingertips, where osteoarthritis is common, but joints at the base of the fingers are often painful.

Nodules

In some patients with RA, inflammation of small blood vessels can cause nodules, or lumps, under the skin. They are about the size of a pea or slightly larger, and are often located near the elbow, although they can show up anywhere. Nodules can occur throughout the course of the disease, although they are usually a sign of more severe disease. Rarely, nodules may become sore and infected, particularly if they are in locations where stress occurs, such as the ankles.

Fluid Buildup

Fluid may accumulate, particularly in the ankles. In some cases, the joint sac behind the knee accumulates fluid and forms what is known as a Baker's cyst. This cyst feels like a tumor and sometimes extends down the back of the calf causing pain. Baker's cysts can also develop in people who do not have RA.

Flu-Like Symptoms

Symptoms such as fatigue, weight loss, and low-grade fever may also be present.

Symptoms in Children

In children, juvenile rheumatoid arthritis, also known as Still's disease, is usually preceded by high fever and shaking chills along with pain and swelling in many joints. A pink skin rash may be present.

Review Date: 02/16/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)