Rheumatoid arthritis varies in severity from one person to another. In some people, RA is mild and may only last for a few months or years and then disappear. Other people experience severe RA that lasts for a lifetime, rarely remits and causes disability. Between these two extremes are many people whose RA is moderate and characterized by symptoms that come and go, called flares and remissions.

When the disease is active, patients are said to be experiencing a "flare;" when the disease is inactive, they are said to be "in remission." During periods of remission, symptoms disappear and patients feel well again. Periods of remission can vary in length, lasting for weeks, months or even years. Remissions can take place in response to treatment or they can occur naturally for no apparent reason.

Stiff, swollen, painful joints

This is often the first symptom of RA. Almost always, the wrists or the knuckle joints in the fingers are affected, excluding the joints closest to the fingertips. Any other joints can be affected, commonly those of the elbows, shoulders, neck, jaw, hips, knees, ankles, or the joints in the balls of the feet. Joints are tender and may be appear red or feel warm, due to inflammation of the tissues in the lining of the joint. Inflammation may cause enough pain to interfere with movement. Swelling and pain in the joints must last for at least six weeks before RA will be considered a possible diagnosis.

Symmetrical involvement of joints

One distinguishing characteristic of RA is that joints tend to be affected bilaterally, in a symmetrical pattern that is not typical of other kinds of arthritis. For example, if the left knee is affected, the right knee is affected too. If the right elbow is affected, the left elbow is affected as well. Sometimes, however, pain may be more intense on one side of the body than the other, if the person uses that side more often. A right-handed person, for example, may experience more pain the right hand than in the left hand.

"Flu" Feelings

RA patients sometimes report generally feeling as if they have the flu. They may feel fatigued, run a low-grade fever, lack appetite, and feel achy and stiff. Sometimes patients also lose weight.

Morning Stiffness

A classic symptom of rheumatoid arthritis is morning stiffness that lasts for an hour or more. This happens after long periods of inactivity too. This lengthy morning stiffness distinguishes RA from the stiffness of osteoarthritis, which typically clears up in 30 minutes or less.

Rheumatoid Nodules

About 20% of RA patients will develop rheumatoid nodules under the skin. These firm nodules are caused by inflammation of small blood vessels. They are usually painless, about the size of a pea, or larger, and can be located anywhere near joints, often around the elbows or fingers. Infrequently, these nodules can become irritated or infected if they are in areas that undergo repeated trauma. Rarely, these nodules are also seen deeper inside the body on tissues that line the lungs, brain, chest cavity or spinal cord.

Rheumatoid arthritis is a "systemic" disease; that is, it affects the entire body. Here are some of the ways RA can affect the other organs in the body.

Changes in Blood Cells

RA can cause anemia, a reduction in the number of red blood cells. Anemia reduces the supply of oxygen to tissues and organs, causing patients to feel tired, look pale and become short of breath. Rarely, RA can also lower the body's white blood cell count, which may increase a person's risk for infections.

Vasculitis

Vasculitis is inflammation of the blood vessels. This rare but serious complication can interfere with blood circulation. Impaired circulation can affect nerve function, resulting in numbness or tingling sensations. If finger or toe arteries are affected, tissue may be damaged and gangrene can result. Vasculitis may cause tiny black areas around the nail beds or ulcers on the legs.

Pleuritis

RA can cause pleuritis, an inflammation of the pleura, or lining of the lungs. This can result in chest pain, coughing or a collection of fluid in the chest cavity around the lungs.

Eye Problems

People with RA or other autoimmune diseases, such as lupus or scleroderma, sometimes also experience Sicca syndrome or Sjogren's syndrome. This condition creates inflammation of the lacrimal glands in the eyes, which produce tears, and the parotid and salivary glands in the mouth, which produce saliva. Sicca or Sjogren's syndrome results in dry eyes and a dry mouth, and sometimes in infections in these areas as well.

Another condition that affects the eyes is episcleritis. This is an inflammation of the thin membrane that coats the white part of the eye (the sclera). Episcleritis is not serious, does not last long and is easy to treat. Scleritis is a general term for any irritation of the sclera, including episcleritis. Scleritis generally refers to a more serious condition that affects the entire white part of the eye. It can affect vision and cause pain. It may be difficult to treat, and patients usually receive anti-inflammatory or immunosuppressant drugs.

Fluid Accumulation

Fluid sometimes accumulates around the heart in a condition known as pericarditis. Pericarditis is an inflammation of the pericardium, the lining around the heart. This condition creates chest pain and breathing difficulty.

References

First published September 1, 1999
Last updated December 16, 2002
Copyright © 1999 Accordant Health Services, Inc. All Rights Reserved.

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