Rheumatoid arthritis (RA) is a chronic (long-term) disease. Rheumatoid arthritis symptoms can come and go, and each person with RA is affected differently. Some people have long periods of remission. Their rheumatoid arthritis is inactive, and they have few or no symptoms during this time. Other people might have near-constant rheumatoid arthritis symptoms for months at a stretch.

Although rheumatoid arthritis can involve different parts the body, joints are always affected. When the disease acts up, joints become inflamed. Inflammation is the body's natural response to infection or other threats, but in rheumatoid arthritis inflammation occurs inappropriately and for unknown reasons.

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Rheumatoid Arthritis Symptoms: Joint Inflammation

Joint inflammation is a hallmark of rheumatoid arthritis. That includes:

Stiffness. The joint is harder to use and might have a limited range of motion. Morning stiffness is one of the hallmark symptoms of rheumatoid arthritis. While many people with other forms of arthritis have stiff joints in the morning, it takes people with rheumatoid arthritis more than an hour (sometimes several hours) before their joints feel loose.
Swelling. Fluid enters into the joint and it becomes puffy; this also contributes to stiffness.
Pain. Inflammation inside a joint makes it sensitive and tender. Prolonged inflammation causes damage that also contributes to pain.
Redness and warmth. The joints may be somewhat warmer and more pink or red than the neighboring skin.

Which joints does RA affect? The hands are almost always affected, although literally any joint can be affected with rheumatoid arthritis symptoms: knees, wrists, neck, shoulders, elbows, even the jaw. Joints are usually affected in a symmetrical pattern -- the same joints on both sides of the body.

Rheumatoid Arthritis Symptoms That Affect the Entire Body

Rheumatoid arthritis can affect many areas of the body. These effects all result from the general process of inflammation, leading to a wide variety of symptoms of rheumatoid arthritis:

Fatigue
Malaise (feeling ill)
Loss of appetite, which can lead to weight loss
Muscle aches

These feelings have been compared to having the flu, although they are usually less intense and longer lasting.

Rheumatoid arthritis may affect other areas of your body. Involvement of multiple areas of the body occurs is more common with moderate to severe rheumatoid arthritis.

Rheumatoid nodules are bumps under the skin that most often appear on the elbows. Sometimes they are painful.
Lung involvement, due to either damage to the lungs or inflammation of the lining around the lungs, is common but usually causes no symptoms. If shortness of breath develops, it can be treated with medicines that reduce inflammation in the lungs.
Rheumatoid arthritis can even affect a joint in your voice box or larynx (cricoarytenoid joint), causing hoarseness.
Rheumatoid arthritis can cause inflammation in the lining around the heart, but it usually has no symptoms. If symptoms do develop, it may cause shortness of breath or chest pain. In addition, people with rheumatoid arthritis are more likely to develop clogged arteries in their heart, which can lead to chest pain and heart attack.
The eyes are affected in less than 5% of people with rheumatoid arthritis. When the eyes are affected, symptoms can include red, painful eyes or possibly dry eyes.

When you have symptoms of rheumatoid arthritis, early and aggressive treatment can help prevent further symptoms as well as stop progression of rheumatoid arthritis.

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Reviewed by Marc C. Levesque, MD on January 25, 2009

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Do You Have Fibromyalgia Pain?

Cymbalta is approved for the management of fibromyalgia.

Important Safety Information

Cymbalta^® (duloxetine HCl) is approved for the treatment of depression and generalized anxiety disorder, and for the management of diabetic peripheral neuropathic pain and fibromyalgia.

What should I talk about with my healthcare provider?

Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, unusual changes in behavior, thoughts of suicide, anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or extreme hyperactivity. Call your healthcare provider right away if you have thoughts of suicide or if any of these symptoms are severe or occur suddenly. Be especially observant within the first few months of antidepressant treatment or whenever there is a change in dose.

You should also know that:

Suicide is a known risk of depression and some other psychiatric disorders.
Antidepressants may increase suicidal thoughts or behaviors in some children, adolescents, and young adults especially within the first few months of treatment or when changing the dose. No increased risk has been shown for adults over age 24, and risk decreased for those over age 65.
All patients starting therapy should be monitored appropriately and observed closely for new or worsening depression symptoms, suicidal thoughts or behavior, or unusual changes in behavior.
Cymbalta^® is not approved for use in patients under age 18.

Who should NOT take Cymbalta?
You should not take Cymbalta if:

You have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI)
You have uncontrolled narrow-angle glaucoma (an eye disease)
You are taking Mellaril^® (thioridazine)

What other important information should I discuss with my healthcare provider?
Before starting Cymbalta, tell your healthcare provider:

about all of your medical conditions, including kidney problems, glaucoma, or diabetes
about your alcohol use
if you are taking nonprescription or prescription medicines, including those for migraine, to address a possible life threatening condition
if you are taking NSAID pain relievers, aspirin, or blood thinners. Use with Cymbalta may increase bleeding risk
if you are pregnant, plan to become pregnant during therapy, or are breastfeeding an infant

While taking Cymbalta, tell your healthcare provider:

if you have itching, right upper belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of liver problems. Severe liver problems, sometimes fatal, have been reported
if you have high fever, confusion, and stiff muscles to address a possible life-threatening condition
before stopping Cymbalta or changing your dose
if you experience dizziness or fainting upon standing, especially when first starting Cymbalta or when increasing the dose. Your healthcare provider may periodically check your blood pressure while you are taking Cymbalta

If you have any questions, talk to your healthcare provider before taking Cymbalta.

What are the possible side effects of Cymbalta?

The most common side effect of Cymbalta was nausea. For most people who had it, the nausea was mild to moderate. Other common side effects included dry mouth, sleepiness, constipation, decreased appetite, and, increased sweating. This is not a complete list of side effects.

Safety Information and Boxed Warning | Prescribing Information | Medication Guide