Rheumatoid Arthritis (RA) Symptoms and Complications

Rheumatoid arthritis (RA) symptoms are different for each person who has this long-term disease.

Some people have long periods with few or no symptoms. Others feel it for months at a time in an uptick of disease activity called a flare.

Most people have lasting problems with episodes of more severe disease. New and earlier treatment is changing the overall picture, though. More people are having low disease activity or even remission.

RA Symptoms in Your Joints

RA almost always affects your joints. It may take a few weeks or months for the first signs to show. The inflammation it causes often leads to these three hallmark symptoms:

  • Pain. Inflammation inside a joint makes it hurt whether you’re moving it or not. Over time, it causes damage and pain.
  • Swelling. Fluid in the joint makes it puffy and tender.
  • Tenderness. It hurts when you move or push on a joint.

Other RA symptoms include:

  • Stiffness. The joint is harder to use and doesn't move as well as it should. It’s especially common in the morning. Although 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.
  • Redness and warmth. The joints may be warmer and have color changes related to the inflammation.

What Joints Does RA Affect?

RA usually starts in your hands. The most common affected areas on your body are:

  • Elbows
  • Wrists
  • The knuckle where each finger meets your hand (metacarpophalangeal, or MCP, joint)
  • The first joint in your fingers (proximal interphalangeal, PIP, joint)
  • Ankle

But RA can appear anywhere on your body, including:

  • Toes
  • Hips
  • Jaw
  • Knees
  • Neck
  • Shoulders
  • Finger joint closest to the thumbnail

Your symptoms usually are symmetrical, meaning that they show up in the same joints on both sides of your body.

It doesn’t happen often, but RA can also affect joints in your voice box called the cricoarytenoid joints. It can make your voice hoarse. Rarely, you may lose your voice.

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Whole-Body Symptoms

Rheumatoid arthritis symptoms can also go beyond your joints. You could feel:

Extreme fatigue could be a sign of anemia, a lack of healthy red blood cells. Your doctor will test for this as part of your RA diagnosis.

Depression could also cause some of these symptoms. A long-term disease like RA can be challenging to live with. Talk to your doctor if you feel sad or down.

Symptoms That Affect Your Skin

Some people with RA get rheumatoid nodules. These are bumps under the skin. Most of the time, they aren’t painful, and they move easily when you touch them. About one in four people with RA get these skin bumps.

They usually happen on your elbows, but they might show up on other bony areas like:

What RA Does to Your Heart and Lungs

RA can affect more than just your joints. Complications can involve your organs, blood vessels, and bones.

RA can damage your lungs or inflame the lining around them. This causes chest pain that worsens with breathing, called pleurisy. Lung problems are the most common symptoms of RA outside the joints. This may not cause symptoms, or you might notice shortness of breath. Your doctor can treat it with drugs that ease the inflammation in your lungs.

Severe inflammation from RA in your lungs can make the tissue stiff, thickened, and scarred. This is pulmonary fibrosis, a hard-to-treat condition that makes it tough to breathe.

Likewise, RA can inflame the lining around your heart (called pericarditis) or your heart muscle (called myocarditis). You probably wouldn’t notice symptoms from that. There’s a chance you could feel shortness of breath or sharp, stabbing chest pain. If you do, call your doctor. It can also raise your odds of heart failure, atrial fibrillation, and stroke.

When RA gets into the cartilage that connects your ribs to your sternum, it can feel like you’re having a heart attack. This is known as chest wall pain.

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RA and Your Eyes

The most common vision-related complications include:

  • Cataracts, a clouding of the lens in your eye that affects your vision
  • Dry eye syndrome. Whether it’s because of medications or damage to your tear glands, your eyes can’t make a healthy tear film.
  • Scleritis, inflammation and redness in the white part of your eye

Other Body Parts RA Can Affect

  • Bones. The chemicals that cause inflammation can also take a bite out of your bones. It often affects your hips and spine. Sometimes, it’s a byproduct of years of treating RA with steroids.
  • Liver and kidneys. It’s rare for RA to affect these organs. But the drugs that treat it can. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be bad for both. Cyclosporine may cause kidney disease. Methotrexate can damage your liver.
  • Immune system. The medications you take can slow it down. This makes you more likely to get infections.
  • Mucous membranes. You might be more likely to get a condition called Sjogren’s syndrome that dries out moist places in your body like your eyes, your mouth, and inside your nose.
  • Muscles. When inflammation stops you from moving your joints, the attached muscles can get weak. Or you could get a condition called myositis that weakens them. The medications you take for RA can also be to blame.
  • Nerves. RA causes symptoms that range from numbness and tingling to paralysis. It can result from joint damage that RA causes, the disease process itself, or medications that treat it.
  • Blood vessels. RA can cause inflammation of your blood vessels. It can show up as spots on the skin or can cause ulcers in more severe cases.

Track Your Symptoms

RA affects everyone differently. Some people have mild RA. Others have severe cases with joint damage.

Many people with RA have symptoms on most days. Some days may be better than others.

It’s rare, but some people have symptoms only from time to time. They may have months between these flares.

Keeping track of your symptoms may help you better see how your disease is changing or not. You can use pen and paper or apps to record such things as when you have symptoms and for how long, how intense they are, and what things make them worse or better. Remember to take your symptom diary every time you visit your doctor or rheumatologist.

WebMD Medical Reference Reviewed by Michael W. Smith, MD on October 15, 2020

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