Pain in the joints is the hallmark of early rheumatoid arthritis Table 01. The inflammation of rheumatoid arthritis causes joint pain, swelling, warmth, redness, and stiffness. Movement typically worsens the joint pain. Because many joints of the body are affected, rheumatoid arthritis is often associated with a sensation of generalized stiffness, especially in the morning and after inactivity. The stiffness lasts longer than 30 minutes, which is one factor that makes it different from another common type of arthritis called osteoarthritis.
Table 1. Symptoms of Rheumatoid Arthritis
Pain, redness, warmth, swelling, and/or stiffness of the joints Worsening of joint pain with movement Overall stiffness in the morning and after inactivity Fatigue Generally feeling unwell (malaise, flu-like symptoms) Loss of appetite Firm, painless growths under the skin near the joints
In contrast to some other types of arthritis, rheumatoid arthritis affects many joints throughout the body. The joints of the hands, wrists, ankles, knees, and feet are usually most severely affected. The disease usually affects the same joints on the right and left sides of the body (symmetrical).
Several other conditions share symptoms with rheumatoid arthritis. The symptoms of rheumatoid arthritis may overlap with the symptoms of another form of arthritis called gout, and other autoimmune diseases, such as lupus. Tests can usually reveal which condition you actually have.
Rheumatoid arthritis can lead to irreversible joint changes over time. Without early and aggressive treatment, inflammation of the joint can lead to damage of the protective cartilage cushions, erosion of bone, and weakening of the tissues that normally support the joints (muscles, tendons, and ligaments) over time. This damage leaves the joints more susceptible to injury, and often results in deformities of the hands and feet that are usually irreversible. The chronic inflammation in the hands may cause the fingers to assume an unnaturally bent or crooked appearance.
Rheumatoid arthritis can lead to inflammation in other parts of the body, and to other problems, such as rheumatoid nodules Figure 02. These effects most commonly occur in people with high levels of rheumatoid factor Table 02.
Figure 02. Rheumatoid Nodules
Table 2. Possible Effects of Rheumatoid Arthritis
Rheumatoid nodules are firm, round, painless growths that occur under the skin, often near the elbow joints or other bony structures, like the hand joints. These nodules occur in about 20% of people with rheumatoid arthritis. Muscle weakness and loss of muscle mass may occur early in the course of rheumatoid arthritis and most commonly occur around inflamed joints Rheumatoid vasculitis is an inflammation of the blood vessels that can affect any organ from the skin to the brain. Heart and lung complications can result from inflammation of the tissue surrounding the heart and the lungs and the lung itself,. Neurologic symptoms can result from inflammation of the spine and the resulting instability of the upper spine, or from trapping of nerves by inflamed tissues (for example, carpal tunnel syndrome), or due to nerve damage from vessel inflammation. Inflammation of the eye occurs in less than 1% of people with rheumatoid arthritis. Sj?gren's syndrome can occur in people with rheumatoid arthritis. This autoimmune disease is characterized by dryness of mucous membranes, especially the membranes of the eyes and mouth. Felty's syndrome can occur in people with rheumatoid arthritis and is characterized by enlargement of the spleen and a decreased number of immune cells that help to fight off infections. Osteoporosis is a condition characterized by thinning of the bones. This condition can occur in people with rheumatoid arthritis as a result of inflammation and decreased physical activity, and is worsened by steroid treatment.
Genetics and gender partly determine your risk of rheumatoid arthritis. If your mother, father, or sibling has the disease, or if you are a woman, your risk increases. Your total risk for rheumatoid arthritis probably depends on a complex interaction of many different factors. Only a few of these factors have been identified. Genetics play a role in your risk of rheumatoid arthritis. If any of your first-degree relatives (mother, father, and siblings) have rheumatoid factor—positive rheumatoid arthritis, your risk of developing the disease increases fourfold.
Gender also plays a role in a person's risk for rheumatoid arthritis. Prior to age 60, rheumatoid arthritis affects almost three times as many women as men. After that age, men and women are affected at about the same rate. However, middle age is the most common time for it to develop. Only 30% of patients with RA develop it over the age of 60.
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