The symptoms of rheumatoid arthritis tend to come and go. Periods of severe symptoms (flare-ups) will be followed by periods when the symptoms of rheumatoid arthritis are nearly gone. While rheumatoid arthritis can begin suddenly, it usually appears gradually and affects the smaller joints of the body, such as the fingers and toes. The main symptom is pain, and the major sign of the disease is tenderness in nearly all inflamed joints. Eventually, the synovial lining inside the joint becomes thicker.
If a joint on one side of the body is affected, usually the same joint on the other side of the body will also be affected. For example, if the left wrist is inflamed, the right one usually is, too. It usually affects the hands, feet, wrists, elbows and ankles, but it can occur in any joint, even the neck.
Other symptoms or signs include:
- A low-grade fever
- Changes in appearance of the joints
- Difficulty sleeping because of the pain
- Feeling tired, fatigued or unwell in the early afternoon
- Inflammation of the tear glands, salivary glands, linings of the heart and lung, lungs and (in rare cases) the blood vessels. These are more rare today with modern treatment and early recognition of the disease.
- Small lumps (rheumatoid nodules) that form under the skin at pressure points, such as the elbows, hands, feet and Achilles tendons. They may also occur in other places, such as the back of the scalp or in the lungs. These nodules can range from being as small as a pea to as large as a walnut. They usually do not hurt.
- Stiffness that lasts 45 minutes or more when getting up in the morning or after a period of not moving
Causes and Risk Factors
Unlike osteoarthritis, which results from wear and tear on the joints, rheumatoid arthritis is an inflammatory condition. The cause of rheumatoid arthritis is not known. Some researchers suspect that rheumatoid arthritis is triggered by an infection in people who have inherited the tendency to develop rheumatoid arthritis. Other environmental factors are currently being examined as triggers, such as prior exposure to immunizations, medications, etc. Other researchers believe that hormones may play a role in the development or severity of rheumatoid arthritis. We already know that smoking is a risk factor for rheumatoid arthritis susceptibility as well as severity. Women are two to three times more likely than men to develop rheumatoid arthritis. It can develop at any age, but it most often occurs in people between the ages of 25 and 50.
The inflammation and damage to the joints may be a result of the body's immune attacking the joints as if they were foreign bodies. White blood cells, which normally attack bacteria or viruses, move from the bloodstream into the synovium, making it swell and become tender. This inflammation causes proteins to be released that over months and years make the synovium grow thicker. These proteins also damage cartilage, bone, tendons and ligaments. In time, if treatment is not instituted promptly, the joint loses its shape and the bones no longer line up correctly.