Rheumatoid Arthritis Symptoms: Early Signs & Warning Signs

Quick Glance: Common Rheumatoid Arthritis Symptoms

The following symptoms are commonly associated with rheumatoid arthritis and may vary in severity between individuals:

Joint pain, particularly in the hands, wrists and feet
Joint swelling and tenderness
Morning stiffness lasting more than 30 minutes
Warmth or redness around affected joints
Difficulty moving or using affected joints
Tiredness and lack of energy
Mild fever or a general feeling of being unwell
Reduced appetite or unintentional weight loss

Symptoms of Rheumatoid Arthritis That Should Not Be Ignored

Persistent or worsening symptoms of rheumatoid arthritis should be assessed by a healthcare professional, particularly when several symptoms occur together. The table below highlights rheumatoid arthritis symptoms that may warrant medical evaluation and what they may indicate:

Symptom	What It May Indicate
Persistent joint pain, swelling and stiffness	Ongoing joint inflammation that may require assessment for rheumatoid arthritis or another inflammatory joint condition
Morning stiffness lasting more than 30 minutes	Inflammatory arthritis may be considered, particularly when accompanied by joint swelling
Swelling and pain affecting several joints	More widespread joint inflammation
Persistent fatigue, fever or unexplained weight loss	Systemic inflammation or another underlying condition
Firm lumps under the skin near affected joints	Rheumatoid nodules, which can occur in some people with rheumatoid arthritis
Persistent dry eyes or dry mouth	An associated autoimmune condition such as Sjögren syndrome
Persistent cough or shortness of breath	Possible lung involvement or another respiratory condition
Numbness, tingling or weakness in the hands	Possible nerve compression, including carpal tunnel syndrome

Why Do Rheumatoid Arthritis Symptoms Occur?

Rheumatoid arthritis develops when the immune system becomes abnormally activated and causes inflammation in the synovium, the lining of the joints. This inflammation can cause joint pain, swelling, warmth and stiffness, particularly in the small joints of the hands and feet.

Persistent inflammation can gradually damage the cartilage, bone and other structures around the joints. This may eventually reduce movement and contribute to joint deformity. As rheumatoid arthritis is a systemic inflammatory disease, inflammation can also affect areas outside the joints, including the lungs, heart, eyes and blood vessels. This may contribute to symptoms such as tiredness, fever, breathing difficulties or dry eyes in some people.

Symptoms of Rheumatoid Arthritis That Require Immediate Medical Attention

Certain symptoms associated with rheumatoid arthritis may indicate a serious complication or another medical condition requiring urgent assessment. Seek immediate medical attention if rheumatoid arthritis symptoms are accompanied by:

A suddenly hot, swollen and extremely painful joint, particularly with fever, which may indicate a joint infection
Severe difficulty breathing or chest pain
Coughing up blood
Sudden weakness, numbness or loss of coordination
Severe neck pain accompanied by weakness, numbness or difficulty walking
A painful, red eye with blurred vision or other changes in vision

Symptoms of Rheumatoid Arthritis Based on Type

Seropositive and seronegative rheumatoid arthritis are classifications based mainly on antibody test results rather than completely separate diseases. The table below compares the typical symptoms of these two types of rheumatoid arthritis:

Type	Common Symptoms and Features
Seropositive rheumatoid arthritis	Joint pain, swelling and stiffness, often affecting several joints. Rheumatoid factor, anti-CCP antibodies or both may be detected. Some people may have a higher risk of rheumatoid nodules and disease affecting areas outside the joints.
Seronegative rheumatoid arthritis	Joint pain, swelling and stiffness can be similar to seropositive rheumatoid arthritis, but rheumatoid factor and anti-CCP antibodies may not be detected. Diagnosis is based on the overall clinical picture, examination and other investigations.

Symptoms of Rheumatoid Arthritis-Specific Conditions

Rheumatoid arthritis can affect parts of the body beyond the joints. The table below summarises some extra-articular conditions associated with rheumatoid arthritis and the symptoms they may cause:

Condition or Manifestation	Common Symptoms
Rheumatoid nodules	Firm lumps under the skin, often near pressure points such as the elbows or fingers
Rheumatoid vasculitis	Skin ulcers or rashes, numbness, weakness or other symptoms caused by reduced blood flow
Sjögren syndrome	Dry eyes, dry mouth and difficulty swallowing
Rheumatoid lung disease	Persistent cough, shortness of breath or reduced exercise tolerance
Felty syndrome	Recurrent infections, tiredness, fever and an enlarged spleen
Carpal tunnel syndrome	Numbness, tingling, pain or weakness in the hands and fingers

These conditions do not occur in everyone with rheumatoid arthritis and may require separate medical assessment depending on the symptoms.

Symptoms of Rheumatoid Arthritis in Children

Children do not usually develop adult rheumatoid arthritis. Instead, inflammatory arthritis that begins before the age of 16 is generally classified as juvenile idiopathic arthritis (JIA), which includes several different types.

Symptoms of juvenile idiopathic arthritis may include:

Joint pain, swelling, warmth and stiffness
Morning stiffness or stiffness after periods of inactivity
Limping or reluctance to use an affected arm or leg
Fever and a pink or light-red rash in systemic JIA
Eye inflammation, known as uveitis, which may sometimes cause few or no symptoms
Swollen lymph nodes in some children
Slower growth or differences in the growth of an affected limb in some cases

Can You Have Rheumatoid Arthritis Without Symptoms?

Rheumatoid arthritis usually causes symptoms such as joint pain, swelling and stiffness, but symptoms can vary over time. Some people experience periods of remission or low disease activity when symptoms become mild or temporarily disappear.

Rheumatoid arthritis can also be difficult to recognise in its early stages because symptoms may be limited or resemble those of other conditions. Some people may have rheumatoid factor or anti-CCP antibodies before typical symptoms develop. However, the presence of these antibodies alone does not confirm rheumatoid arthritis.

When Can Rheumatoid Arthritis Symptoms Become Life-Threatening?

Rheumatoid arthritis is not usually an acute medical emergency, but some complications can become serious if they are not treated promptly. The table below explains some potentially serious complications of rheumatoid arthritis and why they require urgent attention:

Life-Threatening Complication	Why It Is Serious
Joint infection	A severely painful, hot and swollen joint with fever may indicate an infection that can spread if not treated promptly.
Cervical spine complications	Inflammation or instability in the upper spine can put pressure on the spinal cord and may cause weakness, numbness or difficulty walking.
Rheumatoid vasculitis	Inflammation of blood vessels can restrict blood flow and, in severe cases, affect tissues or internal organs.
Severe lung or heart involvement	Inflammation affecting the lungs, lung lining or tissue around the heart can cause serious breathing problems or chest pain.
Serious infection	Some medicines used to suppress the immune system can increase susceptibility to serious infections, which may require urgent medical care.

How are Rheumatoid Arthritis Symptoms Diagnosed?

There is no single test that confirms rheumatoid arthritis. Doctors assess symptoms and perform a physical examination, supported by blood tests and imaging studies. The table below explains the main investigations that may be used when assessing rheumatoid arthritis symptoms:

Diagnostic Test	Purpose
Medical history and physical examination	Assesses the pattern of joint pain, swelling and stiffness and checks for other features such as rheumatoid nodules.
Rheumatoid factor (RF)	Detects an antibody commonly associated with rheumatoid arthritis, although it can also occur in other conditions.
Anti-CCP antibody test	Detects antibodies strongly associated with rheumatoid arthritis and may be present before typical symptoms develop.
ESR and CRP	Measures markers of inflammation that may help assess disease activity, but are not specific to rheumatoid arthritis.
Complete blood count	Checks blood cell levels and may identify anaemia or other abnormalities.
X-rays	Assesses joint damage and provides a baseline for monitoring progression, although early rheumatoid arthritis may not show changes on X-rays.
Ultrasound or MRI	Can detect joint inflammation and structural changes that may not be visible on X-rays.

FAQs

Q1. What is the first symptom of rheumatoid arthritis?

Ans: There is no single first symptom of rheumatoid arthritis. Early rheumatoid arthritis symptoms commonly include joint pain, swelling and stiffness, particularly in the small joints of the hands and feet, along with morning stiffness and tiredness.
Q2. Can rheumatoid arthritis develop without symptoms?

Ans: Rheumatoid arthritis usually causes symptoms, but rheumatoid arthritis symptoms can be mild or fluctuate over time. Some people also experience periods of remission or low disease activity when symptoms become less noticeable or temporarily disappear.
Q3. Which rheumatoid arthritis symptoms should not be ignored?

Ans: Persistent joint swelling, prolonged morning stiffness, unexplained fatigue with joint symptoms, persistent cough or breathlessness, and numbness or weakness should be medically assessed. These rheumatoid arthritis symptoms can sometimes indicate inflammation or complications affecting other parts of the body.
Q4. Are rheumatoid arthritis symptoms different in men and women?

Ans: The main rheumatoid arthritis symptoms are generally similar in men and women. Rheumatoid arthritis is more common in women, but this difference in prevalence does not mean that men and women usually experience completely different symptoms.
Q5. What are the early warning signs of rheumatoid arthritis?

Ans: Early warning signs of rheumatoid arthritis may include persistent pain, swelling and stiffness in the small joints of the hands or feet, morning stiffness lasting more than 30 minutes, warmth around the joints and unexplained tiredness.
Q6. When should I see a doctor for rheumatoid arthritis symptoms?

Ans: You should see a doctor in case of rheumatoid arthritis symptoms such as joint pain, swelling, or stiffness that persist, particularly when morning stiffness lasts more than 30 minutes, or several joints are affected.
Q7. Can rheumatoid arthritis symptoms vary in severity?

Ans: Yes. Rheumatoid arthritis symptoms can vary between people and may become more severe during flares. Some people also experience periods of remission or low disease activity when rheumatoid arthritis symptoms become less noticeable.
Q8. Which rheumatoid arthritis symptoms indicate an emergency?

Ans: Rheumatoid arthritis symptoms such as severe breathing difficulty, chest pain, coughing up blood, sudden weakness or numbness, serious neurological changes, or a hot and extremely painful swollen joint accompanied by fever require urgent medical assessment.

FAQs

Q1. What is the first symptom of rheumatoid arthritis?

Ans: There is no single first symptom of rheumatoid arthritis. Early rheumatoid arthritis symptoms commonly include joint pain, swelling and stiffness, particularly in the small joints of the hands and feet, along with morning stiffness and tiredness.
Q2. Can rheumatoid arthritis develop without symptoms?

Ans: Rheumatoid arthritis usually causes symptoms, but rheumatoid arthritis symptoms can be mild or fluctuate over time. Some people also experience periods of remission or low disease activity when symptoms become less noticeable or temporarily disappear.
Q3. Which rheumatoid arthritis symptoms should not be ignored?

Ans: Persistent joint swelling, prolonged morning stiffness, unexplained fatigue with joint symptoms, persistent cough or breathlessness, and numbness or weakness should be medically assessed. These rheumatoid arthritis symptoms can sometimes indicate inflammation or complications affecting other parts of the body.
Q4. Are rheumatoid arthritis symptoms different in men and women?

Ans: The main rheumatoid arthritis symptoms are generally similar in men and women. Rheumatoid arthritis is more common in women, but this difference in prevalence does not mean that men and women usually experience completely different symptoms.
Q5. What are the early warning signs of rheumatoid arthritis?

Ans: Early warning signs of rheumatoid arthritis may include persistent pain, swelling and stiffness in the small joints of the hands or feet, morning stiffness lasting more than 30 minutes, warmth around the joints and unexplained tiredness.
Q6. When should I see a doctor for rheumatoid arthritis symptoms?

Ans: You should see a doctor in case of rheumatoid arthritis symptoms such as joint pain, swelling, or stiffness that persist, particularly when morning stiffness lasts more than 30 minutes, or several joints are affected.
Q7. Can rheumatoid arthritis symptoms vary in severity?

Ans: Yes. Rheumatoid arthritis symptoms can vary between people and may become more severe during flares. Some people also experience periods of remission or low disease activity when rheumatoid arthritis symptoms become less noticeable.
Q8. Which rheumatoid arthritis symptoms indicate an emergency?

Ans: Rheumatoid arthritis symptoms such as severe breathing difficulty, chest pain, coughing up blood, sudden weakness or numbness, serious neurological changes, or a hot and extremely painful swollen joint accompanied by fever require urgent medical assessment.