Rheumatoid Arthritis

What Are The Signs And Symptoms Of Rheumatoid Arthritis?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.
Rheumatoid arthritis is a long-term disease - a chronic disease. Symptoms can come and go and each patient is affected differently. While some patents may have long periods of remission, when the rheumatoid arthritis is inactive and few or no symptoms are felt, others may have virtually constant symptoms for long periods.
A patient with sudden onset rheumatoid arthritis may go to bed healthy one night and wake up the next morning in a great deal of pain; possibly unable to get out of bed.
In most cases rheumatoid arthritis begins insidiously. Signs and symptoms develop slowly over a period of weeks or months. The patient may initially experience stiffness in at least one joint; often accompanied by pain when trying to move the affected area. There may be tenderness in the joint. First symptoms are usually felt in the small joints, such as the ones in the fingers and toes.
How many joints are affected varies considerably. However, in nearly all cases the process eventually affects at least five joints at the same time. Unlike systemic lupus or gout, rheumatoid arthritis is an additive polyarthritis - more joints are affected as time passes.
Usually both sides of the body are affected, for example, both knees or both hands.
The most commonly affected joints are:

• The proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the hands (middle and base joints of the finger)
• The wrists, especially the ulnar-styloid articulation
• The shoulders
• Elbows
• Knees
• Ankles
• Metatarsophalangeal (MTP) joints (in the toes)

Note: The distal interphalangeal (DIP) joints are not usually affected (top joint of the finger)
The spine is never affected, except the atlanto-axial articulation in late disease. Morning stiffness - morning stiffness is a hallmark symptom of rheumatoid arthritis, especially if it lasts more than an hour. Experts say that the duration of morning stiffness is usually a good indication of the inflammatory activity of the disease. Although patients with other forms of arthritis may have early morning joint stiffness, they tend not to last for more than an hour.
There may be stiffness after long periods of inactivity, which tends to last longer than in cases of degenerative arthritis.
Joint pain and swelling - the lining of the affected joint becomes inflamed - the skin over the joint becomes warm, red and swollen. The area is painful and tender to the touch.

Anemia - according to The National Health Service (NHS), UK, approximately 80% of patients with rheumatoid arthritis are anemic - there is a low number of red blood cells; the blood is unable to carry enough oxygen.
Loss of appetite/Weight loss - a significant number of patients may experience loss of appetite, and subsequent weight loss.
The patient may have red and puffy hands.
The following non-specific systemic flu-like symptoms may be felt weeks to months before other symptoms appear:

• Fatigue (tiredness)
• Malaise
• Depression
• Fever - usually low grade (37° - 38°C; 99° - 100°F). Experts say that a higher fever often indicates an infectious cause (another illness).

Flare-ups
The symptoms of rheumatoid arthritis tend to be intermittent (sporadic); they come and go. Sometimes the patient will have a flare-up - the symptoms will be more intense and severe.
Although flare-ups can occur at any time, they tend to be more painful in the morning, when the patient wakes up. As the day progresses symptoms will start to ease.
Rheumatoid arthritis is a systemic illness (one that affects the entire body)
Multiple organs in the body can be affected, including:

• Inflammation in the lungs - this usually causes no symptoms. If the patient develops shortness of breath medications may be prescribed to reduce inflammation in the lungs.
• Inflammation of the membrane around the lungs (pleura)
• Inflammation of the pericardium - a double-walled sac that contains the heart and the roots of the great blood vessels.
• Inflammation of the tough white outer coat over the eyeball (sclera) - affects about 5% of patients. Symptoms may include red, painful and possibly dry eyes.
• Nodular lesions - about 1 in every 4 rheumatoid arthritis patients develops lumps under the skin - rheumatoid nodules. They tend to occur on the skin over the elbows and forearms. They may be painful, but not usually.
• Inflammation of the tear glands
• Inflammation of the salivary glands
• Inflammation of the cricoarytenoid joint - this is a joint in the larynx (voice box). When it is inflamed it can cause hoarseness.

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