Symptoms and Complications
RA usually develops gradually. The first signs often include muscle and joint pain, fatigue, and stiffness. Just after getting up in the morning, or following a period of inactivity, the joints may feel stiff and take more than an hour to work out, never fully getting better. This is called morning stiffness, but it is not as common or diagnostic as once thought.
Joint pain is the most common symptom and may be accompanied by tenderness, swelling, and redness. Joints affected can include the hands, wrists, feet, elbows, shoulders, neck, jaw, hips, knees, and ankles. The spine is often affected. Fatigue is very common and often disabling, and people with RA may have anemia.
A hallmark of RA is that it is usually symmetrical, while most other types of arthritis are not. Symmetrical means that if a joint on one side becomes affected, within a relatively short time (i.e., days, weeks, a month or two), the corresponding joint on the other side of the body will also become involved.
Left untreated, joints can become deformed as the tissues within them are destroyed. Up to 30% of untreated people develop hard lumps (nodules) under their skin, around bony areas such as the knees and elbows. If tear and saliva glands are affected, it can result in dry eyes and a dry mouth, a condition called Sjögren's syndrome.
RA is a systemic disease that can affect the heart, lungs, and eyes.
RA also commonly accelerates and worsens atherosclerosis (hardening of the arteries), so your doctor may also monitor for risk factors like high blood pressure, cholesterol, and diabetes. Your doctor may also advise you to not smoke. Treatment for atherosclerosis is very important.
One-third of sufferers have a mild form of RA with very few flare-ups of their symptoms. 10% might only have one painful episode and then go for a long period with no other signs of the disease. For many though, symptoms only get worse over time.