Morning stiffness and symmetrical joint pain are the most recognizable symptoms of rheumatoid arthritis. However, the first symptoms to occur are usually fatigue, weakness, low-grade fever or loss of appetite and weight.
These conditions can arise even before joint problems develop. Because these symptoms are common and occur in many other illnesses, you and your doctor may not initially suspect arthritis.
When morning stiffness occurs with rheumatoid arthritis, it usually lasts more than an hour and gradually improves during the day. By comparison, morning stiffness typically lasts less than half an hour in people with osteoarthritis. Stiffness tends to last longer when rheumatoid arthritis is more severe and generally increases after long periods of sitting.
With osteoarthritis, joints ache and feel tender, but there is little or no swelling. In people with rheumatoid arthritis, however, affected joints become inflamed (red, warm, swollen and painful).
Rheumatoid arthritis typically starts on both sides of the body at once and occurs in small as well as large joints, especially in the hands and fingers, wrists, knees, ankles and feet. The symmetrical pattern and the presence of inflammation distinguish rheumatoid arthritis from osteoarthritis. Unlike osteoarthritis, rheumatoid arthritis rarely affects the top joints of the fingers (those closest to the fingernails).
Some people who have rheumatoid arthritis develop rheumatoid nodules—hard lumps of tissue under the skin, especially near the elbows. Rheumatoid nodules often indicate more severe disease activity (ongoing inflammation); they sometimes disappear when disease activity lessens.
Rheumatoid arthritis is a disease that waxes and wanes. It is marked by periods of increased disease activity, known as flare-ups or flares. These flares are characterized by worsening joint pain, stiffness and inflammation. When rheumatoid arthritis flares, the continuing inflammatory process can lead to irreversible joint damage.
Rheumatoid arthritis inflammation may spread to membranes and connective tissues throughout the body. For example, some people develop inflammation of the membrane lining the chest wall (pleurisy). Nerve damage (neuropathy) may occur when an inflamed joint compresses a nerve. Many people with rheumatoid arthritis also develop mild anemia (decreased number of red blood cells).
In about 10 to 15 percent of people with rheumatoid arthritis, primarily women, glands around the eyes and mouth are affected, causing decreased production of tears and saliva. This condition is known as Sjögren’s syndrome.
Less frequently, rheumatoid arthritis causes inflammation of blood vessels throughout the body (vasculitis) or in the membrane surrounding the heart (pericarditis). A rare complication is Felty syndrome, in which the spleen enlarges and white blood cell count drops, leading to recurrent infections.
In later stages of the disease, damage to cartilage, tendons, ligaments and bones causes deformity, weakness and immobility. Individuals who have advanced rheumatoid arthritis frequently have trouble performing tasks such as buttoning a blouse or shirt, combing their hair, tying shoelaces, holding a fork, opening doors or turning the steering wheel of a car. Severe rheumatoid arthritis also makes people with the condition more susceptible to infection and increases the risk of developing heart disease.