Rheumatoid arthritis is a long-term inflammatory autoimmune disease that can cause a wide variety of symptoms.

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These can come and go, but without treatment, they can progress steadily. Symptoms affect each person differently.

Some people can have long periods of remission when they experience few or no rheumatoid arthritis (RA) symptoms. Others may have persistent symptoms for long periods.

A person is more likely to experience remission if they are receiving effective treatment. If symptoms persist, this may be a sign that treatment is not working.

RA usually begins gradually, and symptoms develop over several weeks or months.

The first sign may be stiffness, tenderness, and pain in at least one joint, especially when the person tries to move the joint or on awakening in the morning.

Symptoms usually appear first in the small joints, such as the ones in the fingers and toes. RA can affect the knuckles in the hands and similar joints in the feet, in particular.

The number of joints RA affects varies, but it typically affects at least five joints at the same time.

RA can worsen and affect more joints as time passes.

A person with sudden onset RA may go to bed one night and wake up the next morning in a great deal of pain. Sometimes, the pain is so severe that they may be unable to get out of bed.

RA usually affects both sides of the body, for example, both knees or both hands.

Learn more about the early signs of RA here.

RA causes joint pain and swelling because of inflammation in the lining of the affected joint. The name of the cells and tissue that line the joint space is the synovium, and this type of inflammation is called synovitis.

The skin over the joint can become warm, red, and swollen. The area is painful and tender to the touch.

In low grade, chronic synovitis, the overlying skin may not feel especially warm, but a person may feel synovial thickening when they touch or manipulate the joint.

RA most commonly affects:

  • the middle and base joints of the finger, but not usually the top joint
  • the wrists
  • the shoulders
  • elbows
  • knees
  • ankles
  • the toes

It does not affect the spine, except for a cervical joint in the upper neck known as the C1–C2 joint, which has a synovial lining. Nowadays, however, this is less common because effective treatment prevents it from developing.

The hands may become red and puffy.

Find out how RA affects the ankles.

Learn here how it affects the elbow.

Morning stiffness is a hallmark symptom of RA, especially if it lasts more than 30 minutes, according to the Arthritis Foundation. Stiffness often improves with a warm shower.

When inflammatory activity is high, stiffness may last longer. It also tends to last longer than it does with osteoarthritis (OA) and other types of arthritis.

Stiffness may also occur after long periods of inactivity.

RA can cause inflammation in the joints and throughout the body, resulting in a range of flu-like symptoms.

These may occur for some weeks or months before other symptoms appear, and they can continue alongside other symptoms.

They include:

  • fatigue
  • a general feeling of being unwell
  • a low mood
  • a fever, which is usually low grade

A higher fever may indicate another type of illness.

In the past, iron-deficiency anemia was common with RA. Now, however, newer drugs help reduce inflammation, and the risk of anemia is lower.

Some people experience a loss of appetite. Weight loss can result.

Some people with RA have an additional autoimmune disease, known as Sjögren’s syndrome. Symptoms include dry eyes and a dry mouth, which can lead to tooth decay and fatigue.

Eye dryness can cause significant discomfort, especially in certain settings, such as in an airplane.

A doctor should check for these symptoms, as treatment can prevent further complications.

RA can also lead to brain fog, which makes it difficult to concentrate and remember things.

RA symptoms tend to be intermittent, which means they come and go.

During a flare-up, the symptoms will be more intense and severe. During a time of remission, there may be no symptoms.

Flare-ups can occur at any time, but they tend to be more painful in the morning when the person wakes up. As the day progresses, symptoms usually start to ease.

Applying heat, such as a warm shower, may help.New drugs, known as biologics, may help prevent flare-ups and joint damage over time.

Learn more about RA and biologics here.

RA can cause inflammation in other parts of the body.

The lungs: Inflammation may affect the lungs. Some people may not experience any symptoms, while others may feel short of breath. If this occurs, a doctor can prescribe medications to manage inflammation. Lung changes affect up to 80% of people with RA, but most do not have symptoms.

The pericardium: Inflammation in the sac that contains the heart and the roots of the major blood vessels can lead to chest pain and impair the heart’s pumping action.

The eyes: Inflammation affects the sclera, the tough, white outer coat over the eyeball. Eyes may be red, painful, and possibly dry. There may also be inflammation of the tear glands.

Nodular lesions: Some people with RA develop lumps under the skin, known as rheumatoid nodules, especially around the elbows and forearms. They tend to form on pressure points, for example, where the arms rest on a table. They are sometimes painful. Nowadays, effective treatment makes nodules less likely.

The voice box: RA can affect the cricoarytenoid joint, which is in the larynx, or voice box. Inflammation can lead to hoarseness. If a person has Sjögren’s, nodules can form in the vocal cords, leading to hoarseness.

Salivary glands: Symptoms include a dry mouth and irritation or infection of the gums, which can increase the risk of dental decay and tooth loss. Salivary glands in the cheek area can also become swollen, tender, and chronically infected.

Sore tongue: Having a dry mouth increases the chance of an overgrowth of yeast in the mouth. Typically, a yeast infection causes the tongue to be white, but dryness can cause it to become tender, red, and cracked. People should speak to their doctor if they have a sore, burning tongue.

Blood vessels: Inflammation can affect many parts of the body, resulting in damage to the nerves, skin, and other organs.

Some people report hair loss, whether as a result of RA or its treatment. Learn more here about hair loss and RA.

Systemic inflammation can have a wide-ranging impact.

The Centers for Disease Control and Prevention (CDC) note that people with RA also have a higher risk of various other conditions, such as:

  • heart disease
  • diabetes
  • depression due to physical and social factors, such as employment difficulties

People with both obesity and RA have a higher risk of conditions that commonly occur with obesity, such as high blood pressure and high cholesterol.

Cigarette smoking can trigger the development of RA. Avoiding smoking can help to stop the symptoms from becoming worse.

Being physically active during times of remission can help strengthen the body and the immune system and promote a feeling of well-being.

Following a healthful diet that contains plenty of fresh fruit and vegetables may also help relieve symptoms.

Suitable choices include:

  • raw or lightly cooked green vegetables
  • spices such as ginger and turmeric

Get some tips on the anti-inflammatory diet and find a meal plan and some recipes here.

Learn more about the risk factors for RA.

RA can lead to a wide range of symptoms and complications. Symptoms usually develop slowly and may include stiffness, tenderness, and pain in up to five joints, and flu-like symptoms.

Anyone who thinks they may be experiencing symptoms of RA should visit their doctor for a diagnosis.

Treatment is essential, as, without medication, the symptoms may worsen.

Find out more here about some lifestyle remedies that can help manage RA.