What Are The Symptoms Of Rheumatoid Arthritis?

More than 200 types of Arthritis have been identified. One way that physicians distinguish one type of arthritis from another is by its characteristic location, physical findings, laboratory tests, and x-rays. Early on in the disease, making a diagnosis of RA can be difficult for your physician because your symptoms may change over time. The “classic symptoms” of RA are pain, swelling, stiffness, fatigue, weight loss, and joint deformity. A patient may have all of these symptoms or just a few. The symptoms may be severe and disabling or merely annoying. During the course of the disease, new symptoms can appear and others may disappear with treatment.

Diagnosis

The identification of an illness after review of the patient’s clinical history, physical exam, and laboratory tests.

The main symptom of RA is joint stiffness. This stiffness occurs primarily in the hands or feet and affects the small joints first. When more than one joint is affected, the swelling is symmetrical. That is, the swelling tends to affect the same joints in both the right and left sides of the body at the same time. This condition is generally observed in RA that has been present for a few months or longer. Very early RA may not always be symmetrical, however, which increases the difficulty of making the correct diagnosis. The swelling is usually worse in the morning and improves by midday. Stiffness that persists for an hour or more, or swelling and pain that last for more than six weeks, may also be indicative of RA.

The main symptom of RA is joint stiffness; persistent joint pain is another symptom commonly associated with RA.

In this disease, the lining of the joint, called the synovium, is attacked by antibodies and white blood cells. This attack causes inflammation, redness, and swelling of the joint. The joint can become exquisitely tender, making even small movements impossible. Like the stiffness associated with RA, this

joint pain tends to be symmetrical, although sometimes a single swollen painful joint is the presenting symptom of RA. The joint pain in RA is aggravated by movement or activity, such as walking, getting up from a chair, carrying groceries, or just getting dressed.

Antibodies

Proteins produced by white blood cells to fight foreign proteins, viruses, bacteria, and other unfamiliar invaders.

The pain and stiffness of RA often lead to a decreased range of motion in the affected joints. Range of motion (which is often abbreviated as ROM in physicians’ notes) is the extent to which a joint can be flexed or extended naturally. Thus a restricted or limited range of motion is a reduction in a joint’s normal range of movement. RA can cause a limited range of motion by producing joint swelling, bone erosion, or tissue impingement. Having a limited range of motion can prevent you from getting a can off a high shelf, brushing your hair, or putting on your shoes.

Range of motion (ROM)

Measurement of joint movement angle, which may be restricted due to inflammation.

Erosion

From the Latin erodere, meaning “to eat away”; an eating away of a surface. Erosion of the bone surface of joints is a common feature of many types of arthritis.

Long-standing RA may lead to joint deformity. That is, the chronic inflammation of RA can cause loss of cartilage and bone in the joint. The loss of these tissues may, in turn, cause the joint to become unstable and dysfunctional. As a consequence of these changes, your physician may notice a symptom called crepitus when he or she moves your joint. Crepitus is a crackling, grinding, or grating feeling or sound in the joints when they are flexed and extended. Joint crepitus is associated with significant cartilage loss and joint destruction.

Crepitus

A crackling sound or grating sensation in a joint, caused by swollen synovium or bone surface rubbing together.

In the past, joint deformity and joint destruction were typical outcomes with long-standing RA. Now, however, thanks to newer therapies that are applied earlier, there is a dramatic decrease in the amount of joint deformity and destruction experienced by people with RA.

Not all of the symptoms of RA are associated with the joints. Early-stage RA may produce systemic symptoms such as fever, chills, excessive tiredness, or rash. Small pea-sized lumps called rheumatoid nodules may also develop in the skin. Some

patients experience a loss of appetite that can result in significant weight loss. Anemia (that is, a low red blood cell count) is another common finding in patients with RA.

Rheumatoid nodules

Firm, nonpainful lumps in the skin of patients with rheumatoid arthritis. These nodules tend to occur at pressure points of the body—most commonly, the elbows. They are a sign of long-standing rheumatoid arthritis.

Anemia

The condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. Anemia is associated with rheumatoid arthritis and other chronic diseases. It a complication of the use of nonsteroidal anti-inflammatory drugs (NSAIDs).

When I look back now, although I didn’t realize it at the time, the first signs of my arthritis started about 17 years ago while playing tennis. It just seemed like it would take forever to warm up. My hands and wrist were weak and finally I could hardly hold the racquet. At the time, I got really frustrated, blamed it on my lack of ability and just quit playing. The next time it was an issue was a few years later when I was pregnant with my second child. My hands got so swollen that I couldn’t tie my shoes or even manage to change a diaper. I still didn’t attribute this to arthritis, but rather to swelling caused by my pregnancy. Finally, I started to have severe pain in my feet. I could hardly get out of bed because it was so painful to put pressure on the balls of my feet. This is when I saw my family doctor and he immediately referred me to a rheumatologist.

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