Rheumatoid arthritis is a disease of inflammation that affects joints and other tissues of the body. Typical rheumatoid arthritis symptoms and signs are the most important clues of the disease. They also help distinguish it from the other types of arthritis. The distinction from osteoarthritis is probably the most important since it is the most common of all of the types of arthritis.
Rheumatoid Arthritis Symptoms and Signs Correlated
Rheumatoid arthritis symptoms and signs correlate with how it affects the body and the parts of the body it affects. Inflammation of the synovium is one of the main features of the disease. It most commonly involves the PIP joints, MCP joints (or hand knuckles), wrists and feet including the MTP joints but rarely the DIP joints of the fingers and the IP joints of the thumbs. It often involves the shoulders, elbows, knees and ankles. The disease can affect any joint of the body though including those of the spine. When it affects the spine it involves the cervical spine (neck) far more commonly than it does the lumbar spine (lower back).
Over time it is a polyarthropathy – disease of multiple joints – and is symmetric (involves both sides of the body equally). But early on it might only affect a few joints and be asymmetric. Many of the signs and symptoms of rheumatoid arthritis relate to its pattern of joint involvement. Involvement of MCP joints is particularly unique to it.
Other rheumatoid arthritis symptoms and signs relate to the fact that RA is a systemic (affects the body as a whole) disease. Therefore, it can result in a variety of signs and symptoms depending on other tissue(s) involved and the pathology that results from it. Some of the more commonly affected other tissues are the skin, eyes and lungs.
Symptoms of Rheumatoid Arthritis (RA)
Like other types of arthritis, joint pain is one of the main symptoms of rheumatoid arthritis. In contrast to some types of arthritis though, the pain is chronic. Because of the pattern of joint involvement the pain is most common in the MCP joints, PIP joints, wrists and feet but is fairly common in the shoulders, elbows, knees and ankles. It rarely causes pain in the DIP joints. It is more likely to cause neck pain than lower back pain.
Joint stiffness is another symptom which is fairly specific for RA. It is a sense of difficulty moving joints as opposed to actual reduced range of motion per se. It is usually most noticeable in the morning upon waking up. It might last from one to several hours.
Since rheumatoid arthritis is a systemic illness it can cause symptoms outside of joints. One of the more common ones is fever. The cause is its effect on the immune system. Because it is an autoimmune disease fever might be due to inflammation. It might also be a result of infection due to poor functioning of the immune system caused by RA. Other common non-joint symptoms are fatigue, poor appetite and weight loss. Common symptoms related to its effect on the eyes and lungs are dry eyes, shortness of breath and a chronic dry cough.
Signs of Rheumatoid Arthritis
Physical signs of rheumatoid arthritis serve as clues for patients and doctors. In addition to them, doctors often look for signs on x-rays or blood tests to help make a diagnosis or to determine how severe the disease is.
A major sign of rheumatoid arthritis is swelling and tenderness of involved joints. Affected joints are often also warm to touch. The swelling is doughy or rubbery and is distinct from the bony enlargement of joints which occurs with osteoarthritis. Joint tenderness is often apparent with passive movement or squeezing of the joint. A positive squeeze test is an example and is a strong clue of RA. It consists of pain in the MCP joints when the hand is squeezed, such as during a strong handshake.
Another physical sign that distinguishes RA from most other types of arthritis is the deformities in the hands and feet that occur when the disease has been long-standing. Because the inflammation of rheumatoid arthritis can damage or destroy all joint structures including tendons, ligaments and bones, the deformities it causes are far more disfiguring than those of osteoarthritis caused by just bony overgrowth. When severe, they can be disabling, and are the reason rheumatoid arthritis has been dubbed crippling arthritis.
Skin involvement results in a telltale sign in roughly 20%-30% of people with RA. That sign is the presence of rheumatoid nodules. They are firm lumps of tissue which form mainly under the skin. They are usually not painful but can be a source of pain by putting pressure on surrounding tissue such as nerves and tendons. Their most common sites are on the back of the forearms, elbows and in other pressure points including the knuckles, knees and feet. They are, for the most part, scar tissue with areas of tissue breakdown in the center. They are also comprised of cells of the immune system that promote inflammation.
The most common radiographic – visible on x-ray – sign of RA is joint erosions. They are the eaten-out or gnawed appearance of the bone surfaces of joints. They are the result of destruction of the bone. X-rays will also show the physical deformities previously discussed.
There are two main blood tests that serve as signs of RA. They are the rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (anti-CCP). Either test can be falsely positive or negative in the absence or presence of RA. Therefore, neither test is the sine qua non for making a diagnosis. The tests serve to confirm the diagnosis when typical signs and symptoms of rheumatoid arthritis are present. The RF is more sensitive but less specific than the anti-CCP. The anti-CCP is less sensitive but more specific than the RF. Thus, relying on both tests tends to be more helpful than trusting in either one alone.