Rheumatoid Arthritis: Signs and Symptoms
Rheumatoid arthritis or RA is a disorder of the immune system, which means that the bodily system meant to fight infections and toxins turns on the body itself.
In RA, the patient’s immune system attacks and damages the synovial joints. These are joints in the body that are easy to move, like those in the fingers.
The muscles, ligaments and blood vessels can also be involved. In rare cases, rheumatoid arthritis attacks the patient’s eyes.
RA brings pain, swelling and eventual deformation and loss of function to these joints. The damage can eventually interfere with a person’s ability to perform daily tasks, especially since RA most often attacks the hands.
RA is mostly found in women. They are three times as likely to get the disease as men are, but symptoms of RA in men tend to be more severe.
The disease strikes most often between the ages of 25 and 50, though it is seen in children and older people.
The worldwide prevalence of RA is about 1 percent, according to the Rheumatoid Arthritis Support Network.
What are Rheumatoid Arthritis Symptoms?
Early symptoms of rheumatoid arthritis include:
Fatigue. Though fatigue is somewhat subjective, the patient experiences it as a state of being tired all the time and lacking energy, according to Mayo Clinic.
Myalgia, or muscle pain. Muscle pain can involve one or more groups of muscles or can be widespread all over the body.
Stiffness after the sitting or lying in one place for a long time.
Pain and swelling in at least one joint, especially when the joint is moved. The same joints on both sides of the body are affected symmetrically.
If the patient has an interval where they do not have swelling or pain, the interval should last no longer than three months.
Redness, tenderness, and warmth in joints. This is a sign of inflammation.
Weakness. Weakness is not the same as fatigue, according to WebMD. But weakness and fatigue often accompany each other.
When a person is weak, they lack the strength to do things that used to be easy for them to do when they were healthy. Even moving arms and legs can be strenuous.
Rheumatoid nodules. These are lumps felt and seen beneath the skin. These nodules occur in about 25 percent of all RA patients, according to the Rheumatoid Arthritis Support Network.
These nodules are not dangerous to the patient’s health, but they can be unsightly. They most often appear on the patient’s elbows, forearms, knuckles, and fingers.
They also appear on the backs of the heels, the scalp, the hips and the patient’s knees.
Rarely, they show up on mucous membranes like those found in the lungs, the eyes or the vocal cords. They have even been found in the hearts of a few patients.
Rheumatoid nodules can be tiny and found in clusters or fairly large and found singly. Some can be moved around beneath the skin while others are stationary. Sometimes, they shrink or go away altogether.
Doctors do not know what causes these nodules, though they suspect they might be influenced by pressure or stress on the joints or areas of the body where they appear. Watch this video from Dr. Nabil Ebraheim to learn more about rheumatoid nodules.
Fever. Fever is a body temperature that is higher than normal. The fever in RA is a side effect of its inflammation. Most RA patients have a low-grade fever, which means that the body temperature does not go above 100 degrees Fahrenheit.These fevers come and go.
The elevated body temperature is the result of the body producing chemicals called cytokines, which are there to fight the infection the body senses in the patient’s joints. Cytokines, in turn, produce a substance called interleukin 1, which leads to the fever.
Weight loss. Since the patient’s body is under attack by its own immune system, the body might respond with a loss of appetite as well as the other symptoms that accompany rheumatoid arthritis. This can lead to unintended weight loss.
General malaise. This is a catch-all term that simply means the patient is not feeling well, either physically or mentally. They might not be able to point to any one physical symptom of this feeling.
What are Signs of Rheumatoid Arthritis?
X-rays that show decalcification of the bones. Decalcification means that calcium ions are being leached from the bones. This can lead to the softening and become less dense.
A mild case of this is called osteopenia, while a severe case is an osteoporosis. The symptoms of bone decalcification in rheumatoid arthritis patients include pain in the joints, fingers or toes, headache, falls and fractures, especially of the ribs.
Discovery of rheumatoid factor, or RF. These are antibodies that nearly all people with RA have in their joint fluid.
These antibodies attack other antibodies and lead to tissue destruction. One problem with rheumatoid factor is that people who do not have RA can also have it.
These people can have other immune disorders such as lupus and Sjögren’s syndrome. They can even have non-autoimmune diseases such as syphilis, liver disease, and tuberculosis.
Rheumatoid factor is present in only 80 percent of adults who do indeed have RA. The percentage of children with RA who have a rheumatoid factor is even less than this.
Rheumatoid factor can be detected in a regular blood test. “Normal” levels are less than 14 International units per milliliter. If it is over that, the patient may have an especially aggressive type of RA.
Signs of inflammation found in joint fluid
Biopsy that strongly suggests RA
Are There Other Signs That Suggest Rheumatoid Arthritis is Present?
The appearance of elevated levels of the cyclic citrullinated peptide, or CCP antibodies. Normal levels of these antibodies are 20 international units per milliliter.
If a patient has antibodies that are higher than this, they sometimes have an especially aggressive case of RA.
A mild form of anemia. The type of anemia that people with RA get is the anemia that often accompanies any kind of chronic disease. As many as 60 percents of RA patients suffer from this type of anemia, and it contributes to their feelings of weakness and fatigue.
As with many aspects of RA, medical experts do not know what causes the anemia of chronic disease.
Some speculate that the inflammation of rheumatoid arthritis might compromise the body’s ability to make the red blood cells that carry oxygen and nutrients throughout the body.
Inflammation may also impair the body’s ability to use the iron that the red blood cells carry. This results in the low RBC, or red blood cell count that afflicts many RA patients. Even the drugs taken by RA patients can lead, over time, to anemia.
This is because nonsteroidal anti-inflammatory drugs and corticosteroids can cause irritation and bleeding in the patient’s stomach. This also leads to a slow blood loss.
Elevated C-reactive protein (CRP) levels. C-reactive protein is made by the liver. The liver secretes more of it in the presence of inflammation.
There are two tests for this sign of possible RA. The first is non-specific and simply shows that some inflammatory process is happening in the patient’s body.
The second, called the hs-CRP, find inflammation in the blood vessels and is mostly used to evaluate the patient’s risk of cardiovascular disease.
The CRP levels of a person with RA will be much higher than that of a person with a risk of heart disease.
Their CRP levels can be as high as 100 milligrams per liter, and they need other tests to show if they are at high risk for cardiovascular problems.
Erythrocyte sedimentation rate, or ERS that points to inflammation. This is also called the sed rate test, according to Healthline. It is a simple blood test.
The patient donates blood that is placed in a tube, and the lab times how long it takes for the red blood cells to fall to the bottom.
The red blood cells of people with RA tend to fall quickly because abnormal proteins make them stick together.
These heavier clumps of blood cells fall more quickly than lighter, single cells. Like the other tests, the sed rate test signals that there is inflammation in the patient’s body that points to possible RA when other signs and symptoms are taken into account.
A positive antinuclear antibody test, or ANA. Antinuclear antibodies are those found a high-levels in people who have an autoimmune condition such as RA.
A patient who tests positive for an ANA test has an autoimmune condition, but the test isn’t sensitive enough to show which one it is.
It is yet another sign that the patient may have RA. There are a few tests to measure the patient’s levels of antinuclear antibodies.
These tests are measured in titers, which are measurements of how much antibody is found in the patient’s blood. A titer of 1:160 is considered positive.