The primary symptom of RA is pain in the symmetrical joints (i.e.: both elbows, both knees, and so on). In rare cases, the pain is only in one joint. Most often the pain develops over several weeks, but the pain can come on suddenly. As the pain spreads to other joints, it usually then becomes more symmetrical. The pain is directly related to the amount of swelling in the synovial membranes. When the swelling is at its worst, your joints themselves will feel warm and swollen. The pain can come and go with the swelling.
RA patients also describe severe morning stiffness that can last up to two hours. The stiffness can be so bad that it makes it hard to get dressed, make breakfast, or even get out of bed. This stiffness also corresponds to the synovitis. When the synovitis goes away for a time, so does the stiffness.
About half of RA patients have rheumatoid nodules. As described above, the nodules are hard knots, from the size of a pea to the size of a golf ball, that grow on the sheath of tendons or under the skin. They are usually found on the outside of the elbow, the Achilles tendon on your heel, the underside of your fingers, the lower abdomen, and certain toe joints. The nodules don't usually hurt and over time they tend to shrink or disappear.
Due to RA being a systemic disease, most patients feel tired and weak during flare-ups. About 50 percent of RA patients have systemic inflammation during joint outbreaks of RA.
Conjunctivitis, or inflammation of the eye, is a common symptom of RA. It may be related to a disease of the eye called Sjogren's syndrome, which often occurs along with RA. The main symptom is eye dryness, but patients often can't even feel it.
When RA affects the lungs it can cause an inflammation of the membrane that surrounds the lungs (the pleura.) This inflammation is called pleurisy and results in pain, problems breathing deeply, and sometimes coughing.
RA commonly affects the nervous system, but the symptoms from damage to the nervous system can be hard to distinguish from other symptoms of RA. Damage to the joints in the cervical spine (the neck) can eventually lead to weakness and instability between the cervical vertebrae. This damage can cause problems with the spinal cord as it travels through the neck and in turn, spinal cord symptoms can result.
Common symptoms of affected areas include the following:
Cervical spine (the neck): Symptoms include neck stiffness, weakness, and loss of motion. Ligaments are often inflamed, and there may be problems with the spinal cord or nervous system as explained above. Neck pain alone tends to get better, even when the joints are damaged. Damage to the nervous system, however, does not usually improve.
Shoulders: The main symptom is loss of motion. Your body's unconscious reaction to shoulder pain is simply to not use your shoulders. Since daily life doesn't require large shoulder ranges of motion, frozen shoulder syndrome, in which the shoulder joint’s range or motion becomes severely limited, can set in quickly.
Hands and wrists: Almost everyone with RA has affected wrists and the joints in the middle of your hand and the middle joints of your fingers. The knuckles at the ends of your fingers usually are not. RA can cause joint deformities that freeze your fingers in unusual positions. Rheumatoid nodules and tendon inflammation can make it hard to bend the fingers. Nodules can cause a locking and catching action as your fingers bend.
Knees: Swelling in the knees is common and can be easily seen. A fluid-filled lump called a Baker's cyst often appears behind the knee. It can burst and leak fluid into the calf.
Feet and ankles: RA commonly affects the joints in the middle of the toes and the ankle joints. The deformities and pain in the toes can cause problems with walking. The sole of the foot can feel tingly or numb.
The progression of RA is hard to predict. The swelling of RA ‘flares up’ and dies down such that there may be times when there is not much pain at all. At other times, however, flare-ups cause significant pain. Milder forms of the disease often don't require much treatment. Even milder forms of RA may even go undiagnosed.