Early RA Symptoms and Signs
Joint Pain, Fatigue, Malaise, Reduced Range of Motion, and More
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Medically reviewed by Marissa Sansone, MD
Rheumatoid arthritis (RA) is a type of inflammatory arthritis that primarily affects the joints of the hands, wrists, and knees, but any joint in the body can be affected. Beyond early stage rheumatoid arthritis in hands, some people experience RA that can damage other body systems, including the skin, eyes, heart, and blood vessels.
RA is characterized by damaging inflammation that, left untreated, typically will progress. RA can cause bone erosion and joint deformity. The risk for damage to the joints and other parts of the body is why early diagnosis and aggressive treatment in RA are vital.
In this article, we will cover early-stage RA symptoms that people might experience, and their frequency as well as complications. It will help you to understand how RA symptoms can progress.
Illustration by Shideh Ghandeharizadeh for Verywell Health
Early Symptoms
RA is an autoimmune disease, which means it results from the immune system mistakenly attacking healthy tissues. Researchers aren't entirely sure what starts this process, and it appears to be a combination of genetic, environmental, and other factors.
For many people with RA, the first symptoms will be pain in one joint, or in the fingers, wrists, toes, and ankles. It often affects people between the ages of 20 and 50, but young children and older adults can also have RA. Symptoms can be more severe in early-onset RA.
RA that starts after age 60 is called late-onset RA. It tends to be less severe but can affect larger joints, like your shoulders.
Takeaway
Joint pain, swelling, tenderness, stiffness, redness, and warmth are all ways in which RA affects the joints. Nerves of the joint capsule, the sleeve of fibrous connective tissue around a joint, can become irritated and cause pain.
The earliest signs and symptoms of RA will come on gradually, some even before joint pain and stiffness become noticeable. They include:
Fatigue,the body’s response to inflammation affecting the joints and other parts of the body. Most people with RA report fatigue, which can be a challenging symptom to manage.
Swollen joints. When RA flares up (is active), the joints swell because of thickening of the joint synovium (linings of the joints) and excess joint fluid.
You can usually tell when your joints are swollen. For example, swelling in larger joints can affect your range of motion, or swelling of the fingers can make it harder to remove rings.
Pain or stiffness in the same joints on both sides of your body. RA symptoms tend to be symmetrical (but may not be early on). RA that affects multiple joints without symmetry is referred to as asymmetric polyarticular form arthritis.
Weight loss. Anytime you experience unexplained weight loss without trying to eat better and be active, you should talk to your healthcare provider.
Malaise, a general sense of illness that may include fever, occurs because the immune system has turned against the body’s tissues. attacking the joints and causing inflammation, pain, and swelling.
Related: Uphill Struggle of Rheumatoid Arthritis Fatigue
Advanced Symptoms
There are four stages of RA and its progression, beginning with early-stage disease. Swelling is common in stage 2. By stage 3, joints can start to be deformed and people may experience nerve pain. In stage 4, the joint is essentially immobile and permanently damaged.
Advanced symptoms of RA that you may experience include:
Reduced range of motion: As RA advances, limited range of motion results from swelling and weakness in the joints. Balance, coordination, grip, and dexterity may be affected, and you may develop a limp. (The limp may be an early sign in children.)
More severe stiffness: Joint stiffness is common in RA, especially in the morning. The length of time your morning stiffness lasts will indicate how severe your inflammation is.
Impacts to larger joints: Beyond fingers and toes, you may experience advancing symptoms in the larger joints, including the knees, ankles, wrists, elbows, hips, and shoulders.
Redness: Redness can sometimes be seen in the skin over inflamed joints. The redness results from dilated (widened) skin capillaries (tiny blood vessels) due to nearby inflammation. Joint redness is not always present, especially if inflammation isn’t severe.
People may have more than one joint affected in early RA but arthritis that affects four or more joints (polyarthritis) also can progress. They also may experience complications of more severe and/or untreated disease that include:
Rheumatoid nodules: Some people with RA may experience lumps of tissue that appear on the skin called rheumatoid nodules. Lumps can appear anywhere on the skin, including on the elbows, fingers, and heels. These show up suddenly and grow slowly. Rheumatoid nodules are a sign that your RA is getting worse.
Blood vessel inflammation: RA can cause a condition called rheumatoid vasculitis, which is inflammation of the blood vessels. Vasculitis can cause ulcer-like skin spots to appear on the skin. If vasculitis affects large arteries, it can cause nerve damage that might affect the arms and legs or cause damage to the internal organs.
Eye inflammation: RA inflammation can affect various parts of the eyes, including the episclera (the thin membrane covering the white of the eye) and the sclera (the white of the eye). For many, these conditions can cause redness and pain, but they can also become serious and lead to vision loss.
Lung disease: People with RA have an increased risk for inflammation and scarring of lung disease. RA can also cause lung nodules, pleural disease (inflammation of the linings of the lungs), and small airway obstruction (as the result of chronic inflammation in the walls of the lungs).
Carpal tunnel syndrome: If RA affects the wrists, inflammation might eventually compress the nerve serving the hands and fingers, called the median nerve.
Heart problems: RA inflammation can affect the heart and blood vessels, raising the risk for heart disease. People with RA have a 50% greater risk for heart disease compared to others in the general population.
Anemia: Chronic inflammation in RA can cause the bone marrow to decrease its release of red blood cells (RBCs). The reduced number of RBCs results in anemia when RA is active and disease activity is high. It is not unusual for the anemia caused by RA to resolve when inflammation subsides.
Do the Signs of RA Come On Suddenly or Gradually?
For most people who get RA, joint symptoms will develop gradually over several years. However, some people who get RA will have a severe and more rapid disease course. A few people are fortunate to experience RA for a limited time and then for their RA to go into remission—a period of low disease activity or no symptoms.
Treatment
If you have signs of early-stage rheumatoid arthritis in your hands (or elsewhere), see your healthcare professional as soon as possible. They can diagnose the condition and recommend treatments. If necessary, your primary care provider can refer you to a specialist who treats arthritis, called a rheumatologist.
Early diagnosis and treatment can help manage RA and slow its progression, which may reduce risk or delay some of the complications. The condition will need to be managed for the rest of your life, though different treatment options will be used in different cases. Medications include:
Methotrexate, commonly given as a first-line anti-inflammatory drug. There are both pills and injections available, and it can be used in people with varying levels of disease progression.
Triple therapy with disease-modifying antirheumatic drugs (DMARDs), which combine methotrexate, hydroxychloroquine and sulfasalazine
Biologics like Humira (adalimumab)
Corticosteroids
Managing your RA also may involve physical therapy, treatment for other health conditions, or making lifestyle changes to improve your overall condition, like smoking cessation. In some cases, surgery to treat RA (like carpal tunnel release) may be needed.
Takeaway
You can decrease your risk for RA complications by following your treatment plan. You should also let your doctor know about any new or additional symptoms that arise, no matter how small they seem.
Related: What Are the Risks of Untreated Rheumatoid Arthritis?
Coping
RA cannot be cured (though it can go into remission) and that means making adjustments to improve your quality of life and prevent disease progression. Apart from closely following your treatment plan for early-stage rheumatoid arthritis in your hands (or other RA symptoms), you can:
Exercise for 150 minutes per week, with a focus on range of motion and strength training (like walking or swimming). Don't be afraid to work your way up while avoiding injury.
Choose healthy foods in a balanced diet. Be sure to include fiber, which may help with inflammation. Avoid fried foods, alcohol, refined sugars, and other inflammatory foods.
Choose adaptive techniques at home, like changing storage drawers or using new utensils
Conserve your energy and make sleep a priority. Plan errands and appointments for times of day you typically do well.
Change positions often, and use heat or cold to treat joint stiffness and pain
Consider wellness therapies like deep breathing exercises
If you're interested in a support group, ask your healthcare provider about available options.
Summary
Rheumatoid arthritis is a condition characterized by joint inflammation. It commonly affects the joints of the hands, fingers, feet, and knees. Early signs of RA include joint problems, such as pain, tenderness, swelling, warmth, redness, and stiffness.
Additional signs include fatigue, malaise, loss of range of motion, limping, anemia, low-grade fever, disease symmetry, and multiple affected joints.
There is no cure for RA, but there are many effective treatments that can decrease pain, slow down disease progression, and reduce the potential for joint damage and disability. Early diagnosis and treatment are also vital to reducing the risk for complications from the condition.
