17 Major Signs of Rheumatoid Arthritis a Complete Overview

OVERVIEW: Signs of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a long-term autoimmune disease. The immune system attacks the lining of the joints, causing inflammation, mainly in the small joints of the hands and feet. It can also affect other parts of the body.

RA tends to come in flares, with periods of worse symptoms and periods of remission. The main signs of rheumatoid arthritis are joint pain, swelling and stiffness, usually in a symmetrical pattern, which can lead to joint damage if not treated.

Rheumatoid arthritis can start at any age, but the risk rises as people get older. NIAMS reports that two to three times as many women as men have RA.

The synovium, the thin lining of the joint, becomes inflamed and swollen. Immune cells build up in it, and the thickened lining can wear away cartilage and bone over time, causing pain, stiffness and joint damage.

CAUSES OF RHEUMATOID ARTHRITIS

The exact cause is unknown. These are the major causes of Rheumatoid Arthritis and risk factors:

Genetic factors play a role. Certain genes, including some HLA-DR4 variants, slightly increase the risk.
Female sex is a risk factor, and reproductive and hormonal factors may play a role.
Cigarette smoking is an important risk factor and can make the disease more severe.
Autoimmunity: the immune system mistakenly attacks the body's own joint tissue.
Obesity may also raise the risk.

PRESENTATION OF RHEUMATOID ARTHRITIS

RA usually causes pain and stiffness in the small joints of the hands and feet, on both sides of the body. Less often, it starts in a single joint, such as a knee.

Classic Rheumatoid Arthritis

In most people, RA starts gradually. Fatigue, low appetite, weight loss and general weakness can come first, followed by pain, stiffness and swelling of the small joints of the hands. Over time, larger joints can become involved.

Acute RA

Some people have a rapid onset over days or weeks. This can involve many joints at once and come with fever and other whole-body symptoms.

Palindromic

Few patients present with acute episodes of pain and stiffness of a single joint which lasts for a few days and then returns to normal.

Transient

In some people, the disease is self-limiting and lasts less than 12 months. This type leaves no permanent joint damage.

Rapidly progressive

This type progresses quickly over a few years and can cause joint damage and disability. People with it often test positive for rheumatoid factor and have a higher risk of problems outside the joints.

17 Major Signs of Rheumatoid Arthritis

Joint pain: pain is often worse in the morning or after rest. Sleep can be disturbed by pain.
Morning stiffness: stiffness that lasts more than 30 minutes, and often an hour or more, is typical of RA.
Swelling: soft swelling around the joints, caused by inflammation of the joint lining.
Warmth: the affected joint can feel warm to the touch.
Tenderness: There is pain on movements of joints and on pressure
Restriction of movement: limited movement can lead to muscle wasting around the joints
Subcutaneous nodules: firm lumps under the skin, often over bony areas such as the elbows. Over time, untreated RA can also cause finger deformities such as swan neck and boutonniere deformity.
Joint involvement: the middle and base joints of the fingers, the wrists, knees, ankles and toes are most often involved, while the joints nearest the fingertips are usually spared.
Spindling of fingers: in early stages, swelling of the middle finger joints makes the fingers look spindle-shaped.
Carpal tunnel syndrome: swelling at the wrist can press on the median nerve, causing numbness and tingling in the thumb, index, middle and half of the ring finger.
Knee: the knee can become unstable and bend inward or outward, and weakness of the thigh muscle (quadriceps) is an early feature of knee involvement.
Cervical spine: inflammation in the upper neck can damage bone and ligaments, leading to instability (atlantoaxial subluxation) that can press on the spinal cord.
Musculoskeletal: muscle wasting can occur.
Neurological: carpal tunnel syndrome and nerve damage (neuropathy) can result.
Eye: dry eyes, often from secondary Sjögren's syndrome, are the most common eye problem, and episcleritis can cause a red eye.
Lungs: fluid around the lungs (pleural effusion) and lung scarring (fibrosis) can develop.
Heart: inflammation of the sac around the heart (pericarditis) and a higher risk of heart disease.

HOW TO DIAGNOSE RHEUMATOID ARTHRITIS?

Your doctor will do a physical exam to diagnose rheumatoid arthritis. They may check your joints for swelling, warmth and tenderness, and look for nodules, muscle wasting, carpal tunnel syndrome, dry eyes and dry mouth. They may also check your neck, lymph nodes and spleen.

Investigations:

Rheumatoid factor (RF): present in about 70% of people with RA
Anti-CCP antibodies, which are more specific for RA
ANA (sometimes positive)
Complete blood count
X-ray or ultrasound of the hands and feet
Synovial fluid aspiration
Raised ESR and CRP

TREATMENT OPTIONS FOR RA:

NSAIDs
Steroids
Disease-modifying antirheumatic drugs
COX-2 inhibitors
Immunosuppressants
Biological agents
Combination therapy of methotrexate, hydroxychloroquine and sulfasalazine
TNF inhibitors
IL-6 receptor blockers and other targeted drugs, such as JAK inhibitors

These medicines are prescribed and monitored by a doctor, usually a rheumatologist.

CONSERVATIVE MANAGEMENT:

Rest during flares, balanced with activity (long bed rest is not recommended)
exercise is designed to prevent disease progression and preserve joint motion and muscle strength
heat and cold packs have muscle relaxant and analgesic properties and may relieve the pain
splints provide the joint rest, reduce pain and prevent contractures
weight loss is beneficial especially in RA affecting weight-bearing joints
stopping smoking

PROGNOSIS OF RHEUMATOID ARTHRITIS: the outlook varies. High levels of rheumatoid factor or anti-CCP, early bone erosions, nodules and problems outside the joints are linked to more severe disease.

Modern treatments, started early, help many people control symptoms, prevent joint damage and stay active.

WHEN TO SEEK MEDICAL HELP?

See a doctor if you have joint pain, swelling or stiffness that lasts more than a few weeks, especially in both hands or feet. MedlinePlus notes that RA is an autoimmune disease that needs medical treatment.

The earlier treatment begins, the better the chance of limiting joint damage and complications.