What are the symptoms of rheumatoid arthritis?

Rheumatoid arthritis brings pain and swelling in the hands, wrists, elbows, shoulders, knees, ankles, feet and hips in some combination. There is usually stiffness in the morning on awakening, which may take hours to disappear. And there is often fatigue, which can be severe and limiting. Rheumatoid arthritis can affect almost any age, but is actually most common in the age 20 to 40 and 50 to 60. It is more common in women but happens in men as well.

The most common signs of rheumatoid arthritis (RA) are:

• Morning joint discomfort or stiffness -- usually in the hands or feet -- that lasts more than 30 minutes to an hour after getting out of bed
• Pain, stiffness, or swelling in three or more joints
• Symmetrical joint pain (i.e., joints on both sides of the body are affected)
• Fatigue

Other early warning signs and symptoms of rheumatoid arthritis include:

• Pea-sized lumps, called nodules, under the skin
• Chronic low-grade fever
• Loss of appetite
• Anemia
• Accumulation of fluid (swelling) in your ankles or behind your knees

If you experience any of these symptoms -- particularly joint discomfort -- for more than two or three weeks, make an appointment to see your doctor as soon as possible. Why the rush? If it is rheumatoid arthritis, your best chance of stopping it is with early, intensive therapy -- ideally within three to six months of your first symptoms.

Pain, stiffness, and other symptoms similar to those of rheumatoid arthritis can be caused by many things, from a viral or bacterial infection, to Lyme disease, chronic fatigue syndrome, lupus (another type of arthritis), fibromyalgia, or simply an injury or strain.

If you experience unusual or persistent pain of any kind, make an appointment with a doctor to determine what may be causing your symptoms.

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The onset of rheumatoid arthritis (RA) is usually gradual but occasionally is quite abrupt. Fatigue, low-grade fever, weakness, joint stiffness, and vague joint pain may precede the appearance of painful, swollen joints by several weeks. Several joints are usually involved at the onset, typically in a symmetrical fashion, i.e., both hands, wrists, or ankles. However, in about one third of persons with RA, initial involvement is confined to one or a few joints.

Involved joints are characteristically quite warm, tender, and swollen. The skin over the joint takes on a ruddy, purplish hue. X-ray findings usually show soft tissue swelling, erosion of cartilage, and joint-space narrowing. As the disease progresses, deformities develop in the joints of the hands and feet, although deformities can occur in the neck and shoulders.

Symptoms of rheumatoid arthritis often are similar to those of other types of arthritis and joint conditions. The types of symptoms you experience—and the severity—may differ markedly from those of another person with RA. To make matters more confusing, symptoms can vary in the same person. Symptoms develop over time, and only a few may be present in the early stages of RA.

Often, RA is diagnosed by recognizing the type and pattern of joint involvement. For example, RA usually affects both sides of the body symmetrically.

The typical symptoms of RA include:

• loss of function
• tender, warm and swollen joints
• symmetrical pattern
• joint inflammation often affecting the wrists, fingers, knees, feet and ankles
• fatigue
• low-grade fever
• loss of appetite
• pain and stiffness lasting for more than 30 minutes in the morning or after a long rest

The disease can affect more than just the joints, bones and surrounding muscle. About one-quarter of those with RA develop rheumatoid nodules.  These are bumps under the skin that often form close to the joints. Many people with rheumatoid arthritis develop anemia. Other effects, which occur less often, include neck pain and dry eyes and mouth.  Very rarely, RA results in inflammation of the blood vessels, the lining of the lungs or the sac enclosing the heart.  If you have RA, you may also be at increased risk for infections and gastrointestinal ailments.

If you have any of these symptoms, you should visit a health care professional. Current treatment strategies can help you cope and possibly reduce the impact of the disease.