1. Joint-related Symptoms
RA predominantly affects synovial joints (joints with a fluid-filled cavity), leading to:
a. Joint Pain and Tenderness
- Pain is often constant and may worsen with movement or pressure.
- Early in the disease, smaller joints such as those in the fingers and toes are commonly affected.
b. Swelling
- Affected joints appear swollen due to inflammation and fluid buildup.
- The swelling can feel soft or boggy when touched.
c. Morning Stiffness
- A hallmark symptom of RA, morning stiffness lasts for more than 30 minutes and can persist for several hours.
- This is distinct from osteoarthritis, where stiffness usually improves within 15–30 minutes.
d. Symmetrical Joint Involvement
- RA usually affects joints on both sides of the body symmetrically (e.g., both wrists or knees), although asymmetry can occur in early stages.
e. Warmth and Redness
- Inflamed joints may feel warm and appear reddish, indicating active inflammation.
f. Decreased Range of Motion
- Over time, inflammation and damage to cartilage, ligaments, and tendons can limit joint movement.
g. Joint Deformities (Late-stage RA)
- Chronic inflammation may lead to irreversible joint damage and deformities, such as:
- Boutonnière deformity: Flexion of the PIP joint with hyperextension of the DIP joint.
- Swan-neck deformity: Hyperextension of the PIP joint with flexion of the DIP joint.
- Ulnar deviation: Fingers angle away from the thumb due to joint damage in the hands.
2. Systemic (Whole-body) Symptoms
RA is not limited to the joints. It is a systemic disease that often causes:
a. Fatigue
- A common and early symptom, fatigue is caused by chronic inflammation and can significantly affect daily activities.
b. Low-grade Fever
- Mild fever may accompany flares, reflecting systemic inflammation.
c. Weight Loss
- Unintended weight loss can occur due to the body’s response to prolonged inflammation and decreased appetite.
d. Malaise
- A general feeling of discomfort or unease, often described as “feeling unwell.”
3. Rheumatoid Nodules
- These are firm, painless lumps that develop under the skin, particularly over pressure points such as elbows, fingers, or Achilles tendons.
- Nodules are more common in advanced RA or in individuals with high levels of rheumatoid factor (RF).
4. Extra-articular Manifestations
In about 40% of cases, RA affects other organs and systems:
a. Skin
- Vasculitis (inflammation of small blood vessels) can cause skin ulcers or rashes.
b. Eyes
- Dry eyes: Due to secondary Sjögren’s syndrome.
- Episcleritis: Inflammation causing redness and irritation.
- Scleritis: A more severe form that may lead to vision problems.
c. Lungs
- Interstitial lung disease (ILD): Scarring and stiffness in lung tissue, leading to shortness of breath.
- Pleuritis: Inflammation of the lining of the lungs, causing chest pain.
d. Heart
- Pericarditis: Inflammation of the lining around the heart.
- Increased cardiovascular risk: Chronic inflammation raises the risk of atherosclerosis and heart disease.
e. Blood
- Anemia of chronic disease: Low red blood cell levels due to inflammation.
- Thrombocytosis: Elevated platelet count during active disease flares.
f. Nerves
- Carpal tunnel syndrome: Caused by swelling compressing the median nerve in the wrist.
5. Disease Fluctuations: Flares and Remission
- Flares: Sudden worsening of symptoms, often triggered by stress, infections, or overexertion.
- Remission: Periods when symptoms are minimal or absent. Treatment aims to prolong remission phases.
6. Psychological Impact
- Chronic pain and disability may lead to depression, anxiety, or emotional distress.
- Fatigue and systemic effects can further exacerbate psychological challenges.
Diagnosis of Symptoms
Doctors assess the following for diagnosis:
- Duration of symptoms (typically longer than 6 weeks).
- Affected joint count and pattern (small vs. large joints, symmetrical involvement).
- Laboratory findings (e.g., elevated ESR/CRP, positive RF, anti-CCP antibodies).
- Imaging (X-rays, ultrasounds, or MRIs) showing joint erosion or inflammation.
Why Early Recognition Matters
- Early symptoms like joint pain and fatigue may be subtle but identifying them early helps initiate treatment.
- Disease-modifying anti-rheumatic drugs (DMARDs) can slow disease progression and prevent joint damage.
