Doctors Explain 12 Rheumatoid Arthritis Symptoms to Know

In addition to joint pain, RA can present with symptoms including fatigue, depression, and dry eyes. Below, doctors explain more about rheumatoid arthritis, including the often-overlooked symptoms of the condition.

What exactly is rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disease, meaning that, for whatever reason—probably some combination of genetic and environmental factors or even hormonal changes—a person’s immune system goes rogue. Instead of destroying germs, their infection-fighting white blood cells mount an assault on healthy tissue surrounding the joints. And that process causes joint inflammation and subsequent pain and symptoms. “People will notice they’re puffy or swollen and stiff and they don’t feel well,” Dr. Bykerk notes.

RA symptoms can wax and wane over time, which can make it tough, at least initially, to figure out what your body is telling you. It might start with a few weeks of pain in your wrists or a sore shoulder before symptoms fade away. You might think you have the flu. And just when you thought you were on the mend, another wave of achiness and exhaustion flares up. However, for other people, RA symptoms hit in one fell swoop.

Few people know that better than Tammi Shlotzhauer, M.D., a retired rheumatologist and author of Living with Rheumatoid Arthritis. “I woke up one morning, and I couldn’t get out of bed—boom, thunderbolt,” says Dr. Shlotzhauer. She, of all people, knew what RA looked like and felt like, but it took several months to heed the warning signs, get diagnosed, and start following her own advice. “And when I did that, I got it under great control,” she says.

How to spot rheumatoid arthritis symptoms

There’s no cure for RA, but there are medications and strategies to manage the symptoms. And the earlier you do the things you need to do to protect your joints, the better off you’ll be. Treatments have come a long way, sparing many RA sufferers from undergoing joint surgeries and developing systemic complications that used to be the norm.

“General treatment for RA usually focuses on reducing inflammation, easing symptoms, and preventing long-term joint damage,” says Dr. Hammett. “Most people are treated with medications such as disease-modifying antirheumatic drugs (DMARDs) and biologic medications. Physical therapy, regular movement, stress management, sleep, and an anti-inflammatory diet can all help support overall symptom management. The earlier RA is diagnosed and treated, the better the chances of slowing the disease and protecting joint health over time.”

As an inflammatory condition, rheumatoid arthritis is distinct in many ways from your grandma’s age-related arthritis. If you notice any of these core signs and symptoms, and they last for more than six weeks, make an appointment with a rheumatologist for an evaluation.

Joint pain

Pain is an early and defining symptom of rheumatoid arthritis. It can affect any joint, usually on both sides of the body. It often begins in the small joints of the fingers, wrists, and ankles. Your shoulders, hips, and knees can hurt, too.

The pain can be described as an aching, sharp, throbbing, tender, or shooting, and sometimes causes a burning nerve pain, UK arthritis researchers write in Nature Reviews Rheumatology. RA pain can be “constant or intermittent, localized [to specific joints] or widespread,” the authors note. Wrist pain is a particularly important clue in diagnosing RA because “regular, run-of-the-mill osteoarthritis doesn’t hit the wrists,” Dr. Shlotzhauer explains.

Stiffness

Stiffness that lasts for a half hour or more is a classic sign of rheumatoid arthritis. Most people experience stiffness after they wake up, but other people feel stiff all day, Dr. Bykerk says. And then there are others who say their morning stiffness subsides during the day and then starts up again in the evening, Dr. Bykerk adds. Even sitting for an extended period can cause joints to stiffen up, a phenomenon known as “gelling.”

But no matter when you experience stiffness, it feels like you can’t move the joint or fully straighten it, and this continues for more than six weeks, you should see a doctor, Dr. Bykerk says.

Swelling

RA patients may be bothered by swelling, often the wrists and finger joints that are closest to the hand, long before it becomes evident to other people. “The person sitting at home will have a sense of swelling, but the doctor looking at it may not see it, even though you [the patient] feel it,” Dr. Shlotzhauer says. Not sure if the swelling is all in your head? Try slipping on a pair of shoes. “You might have trouble fitting your shoes if your forefeet are swollen,” Dr. Bykerk says.

Radiating warmth

It may not be super-obvious, Dr. Bykerk says, but sometimes inflamed joints are warm to the touch. If you feel warmth, Dr. Bykerk suggests placing the back of your hand or fingers on the joint and then on a nearby bone. If the joint is warmer than the skin over the nearby bone, that might be a sign of RA—especially if it’s accompanied by other symptoms. “Usually if there’s warmth, there’s a feeling of stiffness, like you can’t move the joint fully or straighten it,” Dr. Bykerk says.

Joint dysfunction

RA can interfere with everyday tasks, especially when you’re having a flare-up. You might have trouble slicing meat, opening a milk carton, or typing on a keyboard, Dr. Bykerk explains. If your knees are a problem, you might have difficulty managing stairs. That’s what happened to Dr. Shlotzhauer. There was a period of time she needed to use a chair lift, she says.

Fatigue

Nearly everyone with RA experiences overwhelming fatigue. It’s a common symptom of many autoimmune conditions. The good news: Once the disease is under control, the fatigue fades away, Dr. Bykerk says. It’s the people who delay treatment who are setting themselves up for trouble because their fatigue can become chronic.

Feeling like you have a bug

RA is more than joint pain. You may feel like you’re coming down with a bug because you’re tired and achy. “It’s a sense of unwellness,” Dr. Shlotzhauer explains. “The person will describe that they don’t feel well, that something’s not right.” If you feel crummy for more than six weeks, see a doctor for an evaluation.

Muscle loss

Muscle loss is a serious complication of RA. When researchers at the University of Pennsylvania examined CT scans, they found “significant deficits in muscle mass and muscle density” in people with RA compared to healthy individuals. If you notice a loss of muscle mass or a significant decrease in your strength, it’s important to tell a doctor. Dr. Bykerk says muscle loss can affect RA patients within a year of developing the condition. “Not only do they have to control the disease, they have to rehab; they have to get strong again,” she says.

Depression

Depression and chronic conditions tend to go hand in hand, and rheumatoid arthritis is no exception. In fact, studies suggest depression is two to four times more common in RA patients than the general population. But unlike some other conditions, depression tends to be an early symptom of RA, rather than something that develops due to having an ongoing health issue. Depression can be a “systemic manifestation of inflammation,” Dr. Shlotzhauer explains. “It is not that you are a person who can’t pull yourself up by the bootstraps. [It’s that] your neurochemistry is affected by inflammation,” she says.

Skin nodules

About one in four people with RA develops firm, fleshy lumps beneath the skin. These so-called nodules usually occur at bony pressure points on the body, such as the knuckles, elbows, and heels. While these protrusions are harmless, sometimes they cause pain, limit function, or become infected, she notes in her book.“There is evidence that the incidence of nodules is decreasing with the decreasing severity of RA over the past decades,” Dr. Sholtzhauer adds—a development she attributes to the introduction of new classes of medication.

Eye or mouth irritation

Sometimes people with rheumatoid arthritis develop symptoms of another autoimmune condition called Sjogren’s syndrome, which attacks the body’s moisture-producing glands. (In people with RA, it’s known as secondary Sjogren’s.) In addition to classic RA symptoms, people with secondary Sjogren’s might experience inflammation of the tear and salivary glands. This may cause eye dryness and mouth dryness, Dr. Shlotzhauer says. But it’s much less severe than primary Sjogren’s.

Nerve, skin, or organ damage

When people think about RA, joint complications typically come to mind, but the condition can also affect other areas of the body. When inflammation attacks your blood vessels, for example, skin ulcers may develop. When it affects the nerves, you may experience numbness or weakness in your limbs.

People with RA are also more likely to likely to develop heart disease independent of other risk factors. And they can develop various lung complications such as interstitial lung disease, which can cause shortness of breath.

RA can also hasten the development of metabolic syndrome, a cluster of conditions — increased blood pressure, elevated blood sugar, and abnormal cholesterol levels—that increase stroke, diabetes, and heart disease risk. If your numbers are borderline and you develop RA, be cautious and ask your doctor how you can stay healthy, Dr. Bykerk says.