What Are the First Signs of Rheumatoid Arthritis? 25 Signs

Rheumatoid arthritis is an autoimmune disease that first targets the joints, but can also cause other systemic conditions.

Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by persistent joint pain, swelling, and stiffness. It can also affect the skin, heart, lungs, and eyes. 

Rheumatoid arthritis differs from some other forms of arthritis because it affects both sides of the body. The most common form of arthritis, osteoarthritis, may affect only one side of the body and is a degenerative condition.

Early signs and symptoms of rheumatoid arthritis come on gradually, often before joint pain or stiffness is noticeable, and may include fatigue, muscle pain, fever, weight loss, numbness and tingling in the hands, and feeling unwell.

When joint pain and stiffness begins, it usually occurs in the small joints, such as those joints at the base of the fingers, the middle of the fingers, and the base of the toes, or may occur in a single, large joint, such as the knee or shoulder, or it may shift from one joint to another

Rheumatoid arthritis usually affects the same joints on both sides of the body (symmetrical). As the condition progresses, joint pain and inflammation become more prominent and symptoms include: 

Joint pain and stiffness that may affect the:

1. Hands
   • May result in carpal tunnel syndrome, which causes weakness, tingling, and numbness in the hand and fingers
   • Finger deformities/bent fingers 
2. Wrist (difficulty bending the wrist backward)
3. Elbow (swelling in the elbow may result in numbness or tingling in the fingers)
4. Shoulder (pain and limited motion)
5. Foot (tenderness at the joints at the base of the toes may cause a person to stand and walk with weight on the heels. The top of the foot may be swollen and red, and the heel may be painful.)
6. Ankle (may cause nerve damage, leading to numbness and tingling in the foot)
7. Knee (difficulty bending the knee and "Baker's cyst," a fluid-filled cyst in the space at the back of the knee)
8. Hips (difficulty walking)
9. Neck (painful and stiff neck, difficulty bending the neck and turning the head)
10. Cricoarytenoid joint (inflammation of a joint near the windpipe that can cause hoarseness and difficulty breathing)
11. Other symptoms of rheumatoid arthritis may include:
12. Bone loss (decreased bone density)
13. Muscle weakness 
14. Skin problems (rheumatoid nodules (painless lumps that appear beneath the skin) 
15. Eye problems (eye redness, pain, and vision problems)
16. Lung disease (shortness of breath and dry cough)
17. Pericarditis (inflammation of the tissue around the heart that can cause chest pain and difficulty breathing)
18. Vasculitis (inflammation of the blood vessels)
19. Sjögren's syndrome causes dry eyes and dry mouth

The cause of rheumatoid arthritis is unknown but it is believed certain factors may affect a person's risk of developing the condition: susceptibility factors and initiating factors.

Susceptibility factors are those that increase a person’s susceptibility to developing rheumatoid arthritis when exposed to certain factors that start the inflammatory process. Susceptibility factors include:

• Age (middle-aged or older)
• Female sex (twice as likely as men to develop RA)
• Genetics (people with a relative who has RA have an increased risk of developing the condition
• Initiating factors (triggers) are those that increase the chances a susceptible person will develop the disease, including:
  • Infection (bacteria in the gut or mouth and gums infection [periodontitis] in particular are risk factors)
  • Smoking 
  • Stress 

The diagnosis of rheumatoid arthritis uses a combination of clinical, laboratory, and imaging information. 

Laboratory studies used to diagnose rheumatoid arthritis include:

• Erythrocyte sedimentation rate 
• C-reactive protein level 
• Complete blood count 
• Rheumatoid factor assay 
• Antinuclear antibody assay 
• Anti−cyclic citrullinated peptide and anti−mutated citrullinated vimentin assays 

Imaging studies used to diagnose rheumatoid arthritis include:

• X-rays (first choice): Hands, wrists, knees, feet, elbows, shoulders, hips, cervical spine, and other joints as indicated 
• Magnetic resonance imaging (MRI): Primarily cervical spine
• Ultrasound of joints: Joints, as well as tendon sheaths, changes and degree of vascularization of the synovial membrane, and even erosions

Joint aspiration and analysis of synovial fluid may be indicated, including:

• Gram stain 
• Cell count 
• Culture 
• Assessment of overall appearance 

Medications used to treat rheumatoid arthritis include:

• Nonbiologic disease-modifying antirheumatic drugs (DMARDS) 
  • Hydroxychloroquine (Plaquenil)
  • Azathioprine (Imuran)
  • Sulfasalazine (Azulfidine)
  • Methotrexate (Rheumatrex, Trexall, Otrexup)
  • Leflunomide (Arava)
  • Cyclosporine (Gengraf, Neoral)
  • Gold salts 
  • Penicillamine (Cuprimine, Depen)
  • Minocycline (Dynacin, Minocin)
• Biologic tumor necrosis factor (TNF)–inhibiting DMARDs 
  • Etanercept (Enbrel, Erelzi, etanercept-szzs)
  • Infliximab (Remicade, Inflectra, infliximab-dyyb, Renflexis, infliximab-abda, Ixifi, infliximab-qbtx)
  • Adalimumab (Amjevita, Cyltezo, Humira, Hadlima, Hyrimoz, Adalimumab-atto, Adalimumab-adbm, Adalimumab-bwwd, Adalimumab-adaz) 
  • Certolizumab (Cimzia)
  • Golimumab (Simponi, Simponi Aria)
• Biologic non-TNF DMARDs 
  • Rituximab (Rituxan)
  • Anakinra (Kineret)
  • Abatacept (Orencia)
  • Tocilizumab (Actemra)
  • Sarilumab (Kevzara)
  • Tofacitinib (Xeljanz, Xeljanz XR)
  • Baricitinib (Olumiant)
  • Upadacitinib (Rinvoq)

Other drugs used to treat rheumatoid arthritis include:

• Corticosteroids 
  • Prednisone (Prednisone Intensol, Rayos)
  • Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol)
  • Prednisolone (Orapred ODT, Pediapred)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) 
  • Ibuprofen (Advil, Motrin)
  • Naproxen (Naprosyn, Aleve, Anaprox, Anaprox DS, Naprelan)
  • Diclofenac (Voltaren, Cambia)
  • Ketoprofen
  • Celecoxib (Celebrex)
• Pain relievers (analgesics)
  • Acetaminophen (Tylenol)
  • Tramadol (Ultram)
  • Topical skin products
  • Diclofenac topical (Voltaren)

Surgical treatments for rheumatoid arthritis include:

• Synovectomy 
• Tenosynovectomy 
• Tendon realignment 
• Reconstructive surgery or arthroplasty 
• Arthrodesis 

Other therapies for rheumatoid arthritis include:

• Heat and cold therapies 
• Orthotics and splints 
• Physical therapy and exercise 
• Occupational therapy 
• Adaptive equipment 
• Joint-protection education 
• Energy-conservation education 

Complications of rheumatoid arthritis include:

• Carpal tunnel syndrome
• Systemic inflammation
  • Lungs (pleurisy or pulmonary fibrosis)
  • Heart (pericarditis)    
  • Eyes (scleritis or Sjögren's syndrome)
  • Blood vessels (vasculitis)
• Joint damage
  • Damage to nearby bone, cartilage, and tendons 
  • Joint deformities 
• Cardiovascular disease
• Cervical myelopathy