Signs and Symptoms of Rheumatoid Arthritis You Shouldn’t Ignore

Arthritis is a very general word. It means there’s joint pain and swelling, but it doesn’t explain the cause. There are many types of arthritis. Osteoarthritis, which happens with aging and joint wear and tear, is the most common. 

On the other hand, rheumatoid arthritis (RA) is caused by inflammation in your body. And it can be complex to manage. But knowing the signs and symptoms of rheumatoid arthritis can help people get diagnosed early and start treatment. This can help to prevent irreversible joint damage. 

What is rheumatoid arthritis?

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

The immune system is like your body’s army. It helps protect you from 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. Other parts of your body, like your eyes or lungs, can also be affected.

RA is a clinical diagnosis. This means there isn’t one 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 even if those tests are normal, you could still have RA. That’s why it can sometimes take a while to get the right diagnosis.

What are the signs and symptoms of rheumatoid arthritis?

Rheumatoid arthritis (RA) is different for every person who has it, and the way it starts can vary too. Early signs of RA may include some or several of the following symptoms. We’ll take a closer look at each of these below.

• Joint pain 

• Joint swelling

• Stiffness

• Fatigue

• Rash

• Fever

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Joint pain

Tender, painful joints are common in RA. It can affect almost any joint in your body, but it’s particularly common in your hands and feet. Often there’s tenderness in other joints, including:

• Wrists 

• Knuckles

• Balls of the feet 

RA joint pain usually happens on both sides of your body (this is called symmetrical pain), and it may come and go. But in early RA, joint pain may 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 about your symptoms.

Joint swelling

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

Stiffness

RA can cause stiffness that makes joints feel like they need to be “oiled.” 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 and doesn’t go away with rest or sleep. 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. 

Rash

Rheumatoid arthritis can also cause changes in your skin. The most common skin change is rheumatoid nodules. They affect up to 40% of people. These are smooth, skin-colored bumps that can grow quite large (up to the size of a lemon). They’re most common on areas of your body that get pressure or trauma, like your:

• Fingers

• Elbows

• Forearm 

• Heels

Some other skin changes and rashes that can be seen with rheumatoid arthritis include:

• Dry skin

• Vasculitis (inflammation of blood vessels)

• Granulomatous dermatitis (a type of rash)

• Sweet syndrome (a rare skin condition with a painful rash and fever)

Fever

Fever can be a symptom of rheumatoid arthritis, but it’s not common. Some studies show that it happens in fewer than 5% of people and it’s usually associated with weight loss and pain in several joints. Fevers can also happen for many different reasons, so if you’re getting unexplained fevers, talk to your healthcare professional.

Who is at-risk for developing rheumatoid arthritis?

Rheumatoid arthritis (RA) can affect people of all ages. But any of the following risk factors can increase your chance of developing it:

• Having certain genes linked to rheumatoid arthritis

• Being female 

• Being older

• Having had certain infections (like Epstein-Barr virus)

• Experiencing childhood trauma

• Smoking

• Being diagnosed with obesity

• Having gum disease 

Are the warning signs for rheumatoid arthritis and osteoarthritis different?

Yes. The main differences between rheumatoid arthritis (RA) and osteoarthritis (OA) are that OA typically:

• Starts with pain in one joint at a time

• Doesn’t cause as much stiffness or swelling as RA

• Affects larger, weight-bearing joints, like your knees, hips, and lower back 

Interestingly, OA can also affect your hands, just like RA. But trained medical professionals can usually tell them apart. For most people, a physical exam is all that’s necessary to make the right diagnosis. That’s because OA affects parts of your hand that RA doesn’t, and vice versa. For example: 

• OA tends to affect the joint at the base of your thumb and the joints nearest to your fingernails. RA doesn’t affect these joints. 

• RA affects the knuckles closest to your wrist, but OA doesn’t.

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

What is rheumatoid arthritis factor?

The rheumatoid factor (RF) test measures the amount of RF antibodies in your blood. RF antibodies are proteins made by your immune system that can sometimes attack healthy cells in your body by mistake. 

The RF test can be used to help diagnose rheumatoid arthritis. But there are some important things to know about the test: 

• It’s possible to have rheumatoid arthritis and a negative RF test. 

• It’s also possible to be healthy and still have a positive RF test. 

• A positive RF test can be a sign of other autoimmune conditions (like Sjögren syndrome).

This is why the RF test must be used in combination with your symptoms, physical exam findings, and other tests to diagnose rheumatoid arthritis. 

Treatment for rheumatoid arthritis

The sooner rheumatoid arthritis (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 ones depend on how severe your condition is and how you respond to the different treatments. But typically, when someone is first diagnosed with RA, early treatment can include:

• A disease-modifying antirheumatic drug (DMARD), like methotrexate, to stop inflammation caused by the confused and overactive immune system

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

• Biologic medications, like Humira and Remicade, which block certain immune signals that are overactive in RA.

When to seek care

If you have joint pain, swelling, or stiffness that isn’t explained by an injury, let a healthcare professional know. Together, you’ll decide if you need a referral to a rheumatologist (autoimmune and joint specialist).

Frequently asked questions

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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:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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