The symptoms for rheumatoid arthritis differ from person to person - but here is a list of the most common ones recorded. You may experience some or all of these.  

Early in the disease, tender, warm, swollen joints may occur on both sides of the body.  This is known as a symmetrical pattern of inflammation and is in direct contrast to osteoarthritis.  In general, the condition usually starts in the hands and feet, affecting most commonly the wrist and the finger joints closest to the hand itself, usually not the joints that are closest to the fingernails except in the case of the thumb.  It can also affect the neck, spine, shoulder, elbow, hip and knee joints.

Pain and stiffness in these affected joints for more than an hour after a prolonged period of rest.  This is particularly evident in the morning and is the classic symptom.

Because the inflammation triggers an autoimmune reaction, the joints are not the only part of the body affected.  For example, tiredness, listlessness and a feeling of generally being run-down, with aches and pains all over the body similar to flu symptoms, can accompany the pain and swelling.

Other general symptoms include:

• Anaemia
• Breathlessness
• Night sweats
• Temperature/fever
• Loss of appetite
• Weight loss
• Irritability 

Occasionally skin, kidneys, eyes, nerves, heart, lungs and tendons can be affected by inflammation - and all sorts of other symptoms can then develop.  Bones may become thin, lungs scarred, the skin ulcerated and so on.

The severity of the symptoms may unpredictably disappear without warning  - but, unfortunately, they are likely to reappear.  Periods of increased disease activity or worsening of symptoms are called flare-ups or flares.  These flares may be broken by periods of remission, where the symptoms fade or disappear.

As the disease progresses, some people develop small lumps of tissue under the skin called rheumatoid nodules.  These are usually not painful and occur in areas that receive pressure such as the back of the elbow.  They can vary in size from a pea to a walnut.

In the long term, prolonged flares can cause the inflamed joints to become damaged as the bones of the joint erode.  Joint destruction can lead to deformities - for example, the wrist may turn towards the thumb side of the hand causing ulnar drift of the fingers.  Alternatively, the swollen tissue may produce damage, causing tendons to rupture.

Although the joints of the hand often look the worst affected, these are the joints that are usually least painful in the non-active stages.  In contrast, the weight-bearing joints of the hips and knees may not show a great deal of deformity, but may be painful.

The disease often continues for many years and may burn itself out.  However, for others it can come and go and settle down after a year or two.  Flares can be 'triggered' - for instance by stress or with certain foods.  Active phases often become less and less frequent.  And whilst it can take years it is still possible that it may one day become inactive.  Unfortunately if your condition has been active for a long time, your joints may well be permanently damaged and disfigured by the time this happens.

15/05/2009