Early Signs and Symptoms of Rheumatoid Arthritis You Shouldn’t Ignore

Arthritis isn’t a very specific word. It means there’s joint pain and swelling, but it doesn’t tell you why. There are many types of arthritis. Osteoarthritis (arthritis that comes with the wear and tear of aging) is most common. On the other hand, rheumatoid arthritis (RA) is caused by inflammation in the body — and it can be complex to manage. But early diagnosis and treatment of RA can get you feeling better faster and prevent irreversible joint damage.

The early signs and symptoms of RA are like clues. When you know what to look out for, you can spot the clues sooner and reach out to your healthcare provider for help. 

What is rheumatoid arthritis? 

Rheumatoid arthritis (RA) is an autoimmune, inflammatory arthritis. It affects about 1 in 200 people. RA is more common in women than men, and it often occurs later in life. But anyone can get RA at any time — even kids.

The immune system is the body’s army. It helps protect against things like infections. But sometimes the immune system gets confused and causes too much inflammation by accident. In RA, this extra inflammation results in painful, swollen, and stiff joints. Sometimes, other parts of the body (like the eyes and lungs) can be affected, too.

RA is a clinical diagnosis. This means there’s no single test that diagnoses it. Instead, healthcare professionals use a combination of clues from your symptoms and physical exam to figure out if RA is the issue. Blood tests and X-rays can help too, but normal tests don’t rule it out. That’s why delays in diagnosis are common.

What are the early warning signs of rheumatoid arthritis?

RA is different for every person who has it, and so is the way it starts. Early signs of RA could include some or several of the following symptoms.

Joint pain

Tender, painful joints are common in RA. It can affect almost any joint in the body, but it particularly likes the hands and feet. Often there’s tenderness at the wrists, knuckles, and balls of the feet. 

RA joint pain is typically symmetric (the same on both sides of the body), and it may come and go. But in early RA, it’s possible for joint pain to start on just one side. To diagnose RA, joint pain must be present for at least 6 weeks. But that doesn’t mean you need to wait this long if you’re in pain. If you’re concerned, reach out to a healthcare professional.

Joint swelling

Swollen, warm, and/or red joints are also common in RA. And this swelling can cause pain, too.  Swelling may make it difficult to bend the fingers and make a fist. Rings may no longer fit or feel too tight.

Stiffness

People with RA often feel stiff, as if their joints need oiling. This stiffness typically lasts longer than 30 minutes a day and improves once you get moving. Stiffness often comes back after periods of inactivity (like sitting on the couch for an hour). In more severe cases, stiffness may last all day.

Fatigue

Fatigue is common in RA, too. Everyone feels tired sometimes, but fatigue due to RA occurs almost every day, no matter how much sleep you get. It’s important to note that fatigue has a lot of causes. If fatigue is your only symptom — and you don’t have noticeable joint symptoms — RA is unlikely. 

Are the warning signs for rheumatoid arthritis and osteoarthritis different?

Yes. In contrast to RA, osteoarthritis (OA) typically: 

• Starts with pain in one joint at a time

• Doesn’t cause as much stiffness and swelling

• Affects larger joints that carry more weight, like the knees, hip, and lower back 

Interestingly, OA can also affect the hands. But trained medical professionals can tell them apart. For most people, a physical exam is all that’s necessary. OA affects parts of the hand that RA leaves alone, and vice versa. For example, OA tends to affect the joint at the base of the thumb and the joints nearest to the fingernails, but RA doesn’t. And RA affects the knuckles closest to the wrist, but OA doesn’t.

But sometimes even the best physical exam can’t tell OA and RA apart. In these cases, blood tests and imaging can help tell the difference.

Early treatment for rheumatoid arthritis 

The sooner RA is diagnosed, the better. That’s because data show that people who start treatment sooner do better in the long run and need less medication to control inflammation. Early treatment also helps prevent irreversible joint damage.

The treatment for RA can involve multiple different medications. The best medications depend on how severe the condition is and how you respond to different treatments. But typically when someone is first diagnosed with RA, early treatment can include a:

• Disease-modifying anti-rheumatic drug (DMARD), like methotrexate, to stop the inflammation caused by the confused and overactive immune system

• Nonsteroidal anti-inflammatory drug (NSAID), like ibuprofen, for short-term pain control

How fast does rheumatoid arthritis worsen?

RA is different for every person who has it, and it worsens more rapidly in some people. But permanent joint damage may occur in as little as 1 year — another reason early diagnosis and treatment are so important.

When to see a doctor

If you have joint pain, swelling, and/or stiffness that isn’t explained by an injury, let your primary care provider know. Together, you’ll decide if a referral to a rheumatologist (autoimmune and joint specialist) is necessary.  

Why trust our experts?

Written by:

Samantha C. Shapiro, MD

Samantha Shapiro, MD, is a board-certified rheumatologist and internist with expertise in autoimmune and inflammatory conditions. She founded the division of rheumatology at Dell Medical School at The University of Texas at Austin.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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