Early diagnosis of any chronic disease can lead to better management of the condition and better quality of life over the long-term. With an inflammatory arthritis condition such as rheumatoid arthritis, which the Arthritis Foundation reports affects about 1.5 million Americans, catching the disease in its earliest stages may help you delay progression of the disease. Controlling the disease may help you avoid disability and deformity, which can be outcomes of dealing with rheumatoid arthritis over the long-term.
But diagnosing rheumatoid arthritis isn't always easy. Although it typically arrives with several hallmark symptoms -- such as bilateral swelling in certain joints in the fingers -- not everyone with RA experiences these symptoms. Some of the other symptoms, such as a low-grade fever or fatigue can be vague or nonspecific and could mistakenly be attributed to other inflammatory or autoimmune conditions.
What Is Rheumatoid Arthritis?
Rheumatoid arthritis is an autoimmune disorder, in which the body's defenses -- the immune system -- erroneously attack the body's own cells rather than the foreign invaders it's designed to deflect, such as viruses and other pathogens. This leads to a robust inflammatory response throughout the body. With rheumatoid arthritis, this response tends to focus on certain joints, and this can lead to the following symptoms:
-- Stiffness. Especially upon first waking in the morning, stiffness in certain joints can be an early sign of rheumatoid arthritis. This stiffness usually loosens up within an hour or so and improves with movement. This is in contrast to the type of stiffness patients experience with osteoarthritis; in that condition, most patients usually wake feeling fairly mobile but stiffness worsens as the joint is used throughout the day.
-- Joint pain and soreness. In addition to stiffness, you may also experience soreness, tenderness or pain in the affected joints, caused by the increase of inflammation in the joint. This pain can be quite debilitating for some people with rheumatoid arthritis, especially when the disease is in its active, or flare-up state.
-- Joint redness and warmth. Redness and warmth in the affected joint are also common signs of inflammation and may point to rheumatoid arthritis as the cause.
-- Joint swelling. "Symptomatically, rheumatoid arthritis is typically associated with swelling," says Dr. Hareth Madhoun, assistant professor of clinical medicine in the department of internal medicine, division of rheumatology at The Ohio State University Wexner Medical Center. And a particular kind of swelling in certain joints may be the differentiator between rheumatoid arthritis and another form of inflammatory arthritis. Called fusiform swelling, this kind of swelling can sometimes make the fingers and toes look "sausage-like," says Dr. Esther Lipstein-Kresch, chief of rheumatology at ProHEALTH Care in New York. Also, it "may feel sort of mushy as opposed to feeling bony," as is usually typical of swelling associated with osteoarthritis, she says.
-- Symmetry of symptoms. One of rheumatoid arthritis's most recognizable symptoms is its symmetry. Unlike some other forms of arthritis, rheumatoid arthritis tends to present equally on both sides of the body. "Typically, what affects one hand is going to affect the other as well," Lipstein-Kresch says.
-- Fever and fatigue. "Because it's an autoimmune problem, patients often have systemic problems," says Dr. David Pugliese, a rheumatologist at Geisinger in Danville, Pennsylvania. "They're excessively tired. They can have low-grade fevers. They can feel like they have the flu or an infection because this is all driven by their immune system." These symptoms are signs of how your immune system is engaged in an inflammatory process.
-- Weight loss. Unexplained weight loss can be an early sign of rheumatoid arthritis. A loss of appetite may also be connected with this drop in weight.
-- Numbness and tingling. Chronic inflammation and swelling can lead to nerve damage and pressure on the nerves that may result in feelings of numbness or tingling in the fingertips. This sensation is also often present in advanced cases of rheumatoid arthritis that have begun to cause damage to the blood vessels.
-- Decreased range of motion. Over time, the inflammation caused by RA can lead to structural damage of the tendons and ligaments inside a joint, which can impede normal range of motion.
Because rheumatoid arthritis is a chronic disease with no cure currently, many of these symptoms are progressive in nature, meaning that they get worse over time. But by carefully managing the disease, many patients are able to lead relatively normal lives and delay the onset of the worst symptoms and complications.
Which Joints Are Affected?
Rheumatoid arthritis tends to affect more joints at once than other types of arthritis. RA often starts in the small joints of the hands and wrists, but it "can also affect large joints," Lipstein-Kresch says. Commonly affected joints include:
-- The proximal interphalangeal joint. The PIP joint is the one in the middle of the finger.
-- The metacarpophalangeal joint. The MPC joint is the joint at the base of the finger, where the finger connects into the rest of the hand. The PIP and MPC are often the first joints to show signs of rheumatoid arthritis.
-- The wrists. The Rheumatoid Arthritis Support Network reports that "the wrist is the most common site of RA in the upper body, and usually, both wrists are involved." Pain, redness, warmth and stiffness in the wrist can all be signs that rheumatoid arthritis is present.
-- The elbows. Pain, swelling, instability, stiffness and frequent locking of the elbow can all signal rheumatoid arthritis in the elbow joint.
-- The shoulders. Pain, stiffness upon waking and pain in both shoulders could signal that RA has begun impacting the shoulder joints. Bumps under the skin in the shoulders or arms called rheumatoid nodules may also signal the presence of RA in the shoulders or elbows.
-- The hips. Inflammation in the hip joint can lead to pain, stiffness and swelling of the joint itself, but may also cause tenderness and stiffness in the thigh and groin area. As the disease progresses, bone erosion can occur, leading to disability and deformity.
-- The knees. Inflammation of the synovium, the membrane that encasess joints, can lead to decreased range of motion in the knees, swelling, pain, redness and warmth.
-- The ankles. Although RA is less commonly found in the ankles, it can affect these joints. Over time, inflammation in the ankles can lead to bone fusion, which makes using the joint normally very difficult. Symptoms in the hips, knees and ankles are usually a sign that the disease has progressed, as RA tends to impact smaller joints first.
-- The metatarsophalangeal joints. The MTP joints connect the toes to the foot. Inflammation in this joint can lead to the development of hammer toe. Pain in this joint in the big toe is also often the hallmark symptom of gout, another kind of arthritic condition.
-- The cervical spine. "Rheumatoid arthritis doesn't affect the lower spine, but it does affect the cervical spine," also known as the neck, Lipstein-Kresch says.
"We don't really know why, but it's very interesting that RA spares the distal joints of the hand so the DIP joint is not involved in rheumatoid arthritis," Lipstein-Kresch says. This joint is the one closest to the fingertip and is commonly affected by osteoarthritis and psoriatic arthritis. "Even in the juvenile form of rheumatoid arthritis, you get involvement of the distal or DIP joint. I can't tell you why it's not affected with (adult) RA," she says. It just isn't.
Other Organs Can Be Damaged
The Arthritis Foundation reports that "ongoing high levels of inflammation can cause problems throughout the body." Many organs can become damaged by this inflammatory process:
-- Eyes. Dryness, pain, sensitivity to light, redness in the white part of the eye and visual impairment can all result from rheumatoid arthritis.
-- Mouth. Gum irritation or infection can result from a drying out of the mouth. Symptoms in the eyes or mouth may also be associated with another autoimmune condition called Sjögren's syndrome that may develop in some patients who have rheumatoid arthritis or occur separately. In Sjögren's syndrome, the immune system attacks the glands that make tears and saliva, causing dry eyes and dry mouth.
-- Skin. Some patients with rheumatoid arthritis develop lumps under the skin. Called rheumatoid nodules, these lumps tend to form over bony parts of the body, typically near joints that are affected by the disease.
-- Blood vessels. The Vasculitis Foundation reports that in some advanced cases of rheumatoid arthritis, another condition called rheumatoid vasculitis can develop. RV features inflammation and narrowing of the blood vessels that may be evidenced by a rash on the skin; pits in the skin of the fingertips; sores around the fingernails; and numbness, tingling and pain in the fingers. This condition can lead to a higher risk of stroke, heart disease and kidney problems.
-- Blood. Your level of red blood cells, called erythrocytes, can drop with rheumatoid arthritis, leading to anemia.
-- Lungs. Rheumatoid arthritis can cause scarring and nodules in the lungs. Also called rheumatoid lung disease, this can develop as a complication of RA and cause shortness of breath, weakness, dry cough, fatigue and unintentional weight loss.
The heart and bones may also suffer adverse consequences as a result of inflammation associated with rheumatoid arthritis. " Patients with rheumatoid arthritis have an increased risk of heart disease compared to the general population," Madhoun says. Therefore, "anything you can do to reduce the cardiac risks of heart attack and stroke, such as quit smoking, keeping cholesterol level normal and so on can reduce the risk of heart disease." This is important because more than 50 percent of premature deaths in people with rheumatoid arthritis result from cardiovascular disease, the Arthritis Foundation reports. Chronic inflammation seems to be the main culprit in that connection between heart disease and RA.
Osteoporosis, a condition in which the body loses bone that can lead to painful and debilitating bone fractures, is also associated with rheumatoid arthritis. Some of the drugs prescribed to treat RA can cause bone loss as a side effect, but some of it is likely attributable to the inflammation caused by RA itself.