Rheumatoid arthritis is a tricky disease to diagnose in its early stages, as patients can develop any of a wide range of symptoms and there is no single diagnostic measure by which RA can be confirmed or denied. Symptoms may not be constant; they may begin slowly, come and go, or progress over weeks or months. Symptoms may appear in one part of the body and disappear for a time (remission) to reappear somewhere else later on (flare).
The “typical” presentation of early RA includes joint stiffness in the mornings lasting for more than 30 minutes and pain and swelling in the small joints of the hands or feet, particularly in those that attach the fingers and toes, which persists for weeks. As the disease progresses, symptoms often spread to larger joints, such as knees, ankles, elbows, shoulders, and hips.
But for many people with RA, early symptoms are less narrowly defined or disease-specific. And diagnosis can be challenging for medical professionals because there are several diseases that can mimic rheumatoid arthritis.
Which of these early signs of RA did you experience?
Fatigue. One of the most common symptoms of several autoimmune diseases is fatigue; RA is no exception. You may experience fatigue before any other symptoms become obvious. In a 2013 survey of more than 1,000 RA patients in the U.S. (conducted by HealthUnion), fatigue was exceeded only by hand/wrist pain as one of the most significant initial symptoms of RA in 56.3 percent and 69.6 percent of survey respondents, respectively.
Morning stiffness. People with RA often experience early morning stiffness that lasts for hours. Stiffness may also occur throughout the day following periods of stillness or inactivity. Osteoarthritis may also cause morning stiffness; however, it will usually last 30 minutes or less.
Joint swelling and tenderness. Mild inflammation which accompanies stiffness may cause joints to appear larger than normal. The inflammation and swelling may also make joints feel warm to the touch and appear red. However, joint swelling may be so subtle as to make it difficult to identify, especially in obese patients.
Joint pain. The pain of early RA frequently involves specific joints of the hands or feet, including the metacarpophalangeal joint (MCP) at the base of each finger, the proximal interphalangeal joint (PIP), or the metatarsophalangeal joint (MTP) at the base of each toe. Keep in mind, however, that early RA pain is not limited to the hands and feet; larger joints may be involved.
Decreased range of motion, numbness, or reduced grip strength. Inflammation can affect tendons and ligaments as well as synovium, restricting range of motion, fluidity of motion, or physical function. Inflamed tendons may put pressure on nerves leading to numbness or weakness. In the 2013 survey mentioned above, 39.9 percent of respondents included reduced grip strength as an early symptom of RA, while 32.7 percent noted general weakness.
Low-grade fever. Often accompanied by general malaise, and in the presence of other symptoms, a low-grade fever may be an early warning sign of RA or a flare-up. However, a temperature above 100°F (38°C) is more likely to signal some other illness or, possibly, an infection.
Abnormal laboratory results. Studies show that anti-cyclic citrullinated peptide (anti-CCP) antibodies may be detected in healthy individuals years before the clinical onset of RA. Most, but not all, people with RA test positive for rheumatoid factor (RF). Nonspecific inflammatory markers, such as erythrocyte sedimentation rate (ESR or sed rate) or C-reactive protein (CRP), are often elevated, but test within normal ranges in about 60 percent of patients with early RA. Additional abnormal blood tests may include high platelet count, low albumin, raised alkaline phosphatase (a liver enzyme), or normocytic-normochromic anemia.
Firm lumps of tissue located under the skin. Rheumatoid nodules tend to grow close to joints affected by RA, such as elbows or wrists. They may be as small as a pea or grow to the size of a walnut. Nodules can also form on vocal cords, or appear in the lungs, heart or other organs.
Extra-articular symptoms. Patients with early RA may develop vasculitis, inflammation of the blood vessels, or serositis, which involves inflammation of the tissue lining the lungs (pleura), heart (pericardium), or inner lining of the abdomen (peritoneum). Pleurisy (inflammation of the lungs) can cause chest pain when you breathe.
Additional symptoms of early RA might include weight loss, difficulty sleeping, dry mouth, eye discharge, and dry, itchy, or inflamed eyes.
Please consult your doctor if you are experiencing any of these early symptoms of RA. Early diagnosis and treatment is vital to limiting disease activity, reducing deformity, and delaying disability.
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Suresh E. Diagnosis of early rheumatoid arthritis: what the non-specialist needs to know. J R Soc Med. Sep 2004;97(9):421-424.
2013 RA in America Study: Early Signs, Diagnosis and Symptoms. RheumatoidArthritis.net. Accessed October 24, 2014 at http://rheumatoidarthritis.net/ra-in-america-2013/early-signs-diagnosis-and-initial-ra-symptoms/