Rheumatoid Arthritis

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Signs and Symptoms

Symptoms of rheumatoid arthritis vary from patient to patient. They can develop suddenly or develop slowly over time. Signs of the disease, such as joint pain and stiffness, often develop first in the small joints in the fingers, hands, and wrists. The distal interphalangeal (DIP) joints (i.e., joints closest to the finger tips) usually are not affected.

In most cases, joint pain and stiffness are more severe following periods of inactivity and upon waking in the morning. In addition to the hands and wrists, joints that are commonly affected by RA include the cervical spine (neck), shoulders, elbows, hips, and knees. The joint that controls movement of the vocal cord, which is called the cricoarytenoid also may be affected, causing hoarseness and, in severe cases, difficulty breathing.

Joint involvement usually is symmetrical, which means that if the symptom develops in a joint on one side of the body, it also occurs in the same joint on the other side of the body.

As the disease progresses, damage to cartilage, tendons, ligaments, and bone can cause deformity and joint instability. This damage can result in loss of joint function, which often leads to difficulty performing every day tasks (e.g., buttoning a shirt, opening a jar).

In addition to joint pain and stiffness, symptoms of RA include the following:

• Anemia (low red blood cell count)
• Depression
• Fatigue
• Flu-like symptoms (e.g., low-grade fever, malaise)
• Loss of appetite
• Muscle pain
• Weakness

Rheumatoid nodules or synovial cysts (lumps of tissue under the skin) may indicate severe disease. These cysts may cause pressure on surrounding nerves and can rupture, causing pain and discomfort in surrounding tissue. Lesions and ulcers (sores) on the skin also can occur.

Complications
RA can affect the glands located near the eyes and mouth, resulting in a condition called secondary Sjögren's syndrome. Decreased tear and saliva production can cause dry mouth, dry eyes, and thinning of the sclera (white part of the eye), which may make the sclera appear bluish in color.

Felty's syndrome is a complication of rheumatoid arthritis. Signs of this condition, which can affect the liver, include an enlarged spleen (splenomegaly) and an abnormally low white blood cell count (particularly neutrophils). In severe cases, the spleen must be removed.

RA also may cause lung (e.g., pleural effusion, fibrosis, nodules, pneumonia) and heart (e.g., pericardial effusion, pericarditis) complications. Patients who have severe RA may be at increased risk for heart attack (myocardial infarction).

Rheumatoid Arthritis, Signs and Symptoms reprinted with permission from podiatrychannel.com
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