The First Signs of Rheumatoid Arthritis (RA): What to Look For

Rheumatoid arthritis (RA) is an autoimmune disease that causes the body’s immune system to mistakenly attack the joints, leading to inflammation, pain, and eventual joint damage. Unlike osteoarthritis, which is more commonly associated with aging and wear and tear, RA can affect people of any age, often developing in adulthood. The first signs of RA can be subtle but are important for early diagnosis and treatment, as early intervention can help slow the progression of the disease. In this report, we’ll explore the initial symptom of RA and ten other signs that can indicate its presence, with each sign explained in depth.

1. Fatigue and General Malaise

The first sign of rheumatoid arthritis to look out for is often fatigue and a general sense of malaise. Before any joint pain or stiffness appears, many individuals with RA report feeling unusually tired, drained, or lethargic. This fatigue can come on suddenly and may not be relieved by rest or sleep. It’s one of the earliest indicators that something is wrong, as the body’s immune system is already attacking the joints, even if outward symptoms are not yet visible.

Fatigue can affect daily functioning, making routine tasks feel more difficult. Additionally, it can be accompanied by a general feeling of illness, such as a slight fever, and a lack of motivation or energy. Fatigue in RA is persistent and more profound than the tiredness people typically feel after a long day.

2. Joint Stiffness, Especially in the Morning

Joint stiffness, particularly in the morning, is a classic and early sign of rheumatoid arthritis. This stiffness is distinct from the stiffness associated with osteoarthritis, as RA stiffness tends to last for an hour or more, whereas osteoarthritis stiffness usually subsides after 30 minutes or less. The joints most commonly affected include the small joints of the hands, wrists, and feet, although other joints can also be impacted.

Morning stiffness may make it difficult to move after waking up, and it often improves as the day progresses or with gentle movement. However, in the early stages of RA, stiffness can occur after any period of inactivity, such as sitting for long periods.

3. Joint Swelling and Tenderness

As RA progresses, joint swelling and tenderness become more prominent signs. The affected joints may appear puffy or enlarged due to inflammation, and they may feel warm to the touch. This swelling is often symmetrical, meaning it occurs in the same joints on both sides of the body. For example, both wrists or both knees might swell at the same time.

The tenderness associated with RA is usually triggered by light pressure on the joint. For example, shaking hands or gripping objects might become painful. The swelling can cause significant discomfort and may lead to a decreased range of motion in the joints.

4. Joint Pain

Joint pain in rheumatoid arthritis is caused by the inflammation of the synovium, the tissue lining the joints. This inflammation leads to swelling, which puts pressure on the surrounding nerves, causing pain. In the early stages of RA, the pain may come and go, often worsening after periods of inactivity or in the morning. As the disease progresses, the pain can become more persistent and severe.

Unlike osteoarthritis, which often affects weight-bearing joints, RA commonly affects smaller joints first, such as those in the hands, wrists, and feet. However, any joint can be affected, including the shoulders, knees, and hips. The pain can limit the ability to perform daily tasks, such as dressing, writing, or walking.

5. Symmetrical Joint Involvement

One of the hallmark features of rheumatoid arthritis is its symmetrical joint involvement. This means that the same joints on both sides of the body are affected. For example, if you notice swelling and pain in your left wrist, it’s likely that your right wrist will also be affected. This symmetrical pattern distinguishes RA from other types of arthritis, such as osteoarthritis, which may affect joints asymmetrically.

This symmetry can extend to other joints, including the fingers, ankles, and knees. It is important to pay attention to whether joint pain and swelling occur in a mirrored fashion, as this is a key indicator of RA.

6. Warmth and Redness Around the Joints

As RA progresses, the affected joints may feel warm to the touch and appear red. This warmth is a result of the increased blood flow to the inflamed area. Redness and warmth around the joints are signs that the immune system is actively attacking the joint, causing inflammation. While the warmth may not always be severe enough to cause noticeable redness, it can still be felt when touching the joint.

These symptoms can vary in intensity, and they may flare up during periods of increased disease activity, known as flares, before subsiding when the disease is in remission. Warmth and redness, when combined with other symptoms, are strong indicators of an RA flare.

7. Low-Grade Fever

In some cases, individuals with RA may experience a low-grade fever as a result of the inflammation in their body. This fever is usually mild, typically below 100°F (38°C), but it can persist and contribute to feelings of fatigue and malaise. The fever may come and go, often flaring up during periods of active inflammation or during RA flares.

If you’re experiencing joint pain, swelling, and a low-grade fever, it’s important to consult a healthcare professional, as these combined symptoms strongly suggest an autoimmune process like RA is at work.

8. Loss of Appetite and Weight Loss

Some individuals with rheumatoid arthritis may experience loss of appetite and unintentional weight loss. This symptom is linked to the body’s systemic inflammation, which can affect various systems, including digestion and metabolism. As the immune system attacks the joints and other tissues, the body uses more energy, leading to weight loss despite a lack of appetite.

In more advanced cases of RA, inflammation can affect other organs, contributing to feelings of illness and loss of appetite. Chronic inflammation can also lead to muscle wasting, further contributing to weight loss and fatigue.

9. Rheumatoid Nodules

Rheumatoid nodules are firm lumps that form under the skin, often near joints affected by RA. These nodules are typically painless and range in size from a pea to a walnut. They most commonly occur on the elbows, fingers, or other pressure points, but they can develop anywhere on the body.

While rheumatoid nodules are not harmful in themselves, their presence is a clear sign of more advanced RA. They can also serve as an indicator that the disease is more severe and systemic in nature, affecting not only the joints but potentially other organs and tissues.

10. Dryness of the Eyes and Mouth (Sjogren’s Syndrome)

A common complication of rheumatoid arthritis is Sjogren’s syndrome, a condition that causes dryness of the eyes and mouth. This occurs because RA can attack the glands that produce moisture, leading to decreased tear and saliva production. Individuals may experience dry, gritty eyes and a dry mouth, making it uncomfortable to chew, swallow, or speak for extended periods.

Sjogren’s syndrome can lead to more serious complications if left untreated, such as corneal damage or dental issues due to the lack of saliva. If you are experiencing persistent dryness along with other symptoms of RA, consult your doctor for appropriate management strategies.

11. Decreased Range of Motion

As rheumatoid arthritis progresses, the range of motion in the affected joints becomes limited. This decreased mobility is a result of inflammation, swelling, and joint damage. The tendons and ligaments surrounding the joints may also be affected, leading to joint deformities or contractures, which can further limit movement.

For instance, individuals with RA in their hands may find it difficult to fully open or close their fingers, while those with RA in their knees may have trouble bending or straightening the joint. This limitation can significantly impact daily life, making tasks like dressing, cooking, or typing difficult or impossible without assistance.

Managing Rheumatoid Arthritis Symptoms

Managing rheumatoid arthritis requires a combination of lifestyle modifications, medications, and therapies designed to control inflammation and prevent joint damage. Early diagnosis and treatment are critical to slowing the progression of the disease and preventing long-term complications.

Exercise and physical therapy play a crucial role in maintaining joint mobility and preventing stiffness. Low-impact activities, such as swimming, cycling, and walking, can help keep the joints flexible and reduce the risk of deformities.

Medications used to treat RA include disease-modifying antirheumatic drugs (DMARDs), biologics, and nonsteroidal anti-inflammatory drugs (NSAIDs). These treatments aim to reduce inflammation, control the immune system’s activity, and relieve pain.

Conclusion

Rheumatoid arthritis is a chronic autoimmune disease with symptoms that range from fatigue and morning stiffness to joint pain, swelling, and deformities. Recognizing these signs early is crucial for obtaining a timely diagnosis and beginning treatment to manage the condition. While there is no cure for RA, early intervention and a comprehensive treatment plan can help reduce symptoms, slow disease progression, and improve quality of life.

Footnotes

Mayo Clinic. “Rheumatoid Arthritis.” Mayo Clinic, 2023. Rheumatoid Arthritis Overview
Arthritis Foundation. “What is Rheumatoid Arthritis?” Arthritis Foundation, 2023. Rheumatoid Arthritis Explanation
National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Rheumatoid Arthritis.” NIH, 2023. NIH Rheumatoid Arthritis Resource
Sjogren’s Foundation. “What is Sjogren’s Syndrome?” Sjogren’s Foundation, 2023. [Sjogren’s Syndrome Overview](https://www.sjogrens.org/