Early and Advanced Symptoms of Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune inflammatory disease, which means that the immune system mistakenly attacks joint tissues. If not treated in a timely manner, it might lead to prolonged inflammation and irreversible joint damage.

Fortunately, new treatments have been developed in the last few years, and although there is still no cure for this disease, its progress can be hindered if diagnosed and treated early. This is why recognizing early signs of rheumatoid arthritis is of utmost importance to avoid joint deformities and other health complications.

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a disease where your immune system (the body's defense system against infections) mistakenly attacks the tissues of your joints, causing them to become inflamed.

Therefore, rheumatoid arthritis is an autoimmune disease. This differentiates it from other types of arthritis, such as osteoarthritis, which happens as a result of the normal aging process, or gout, which occurs due to the deposit of uric acid crystals in the joints.

Rheumatoid arthritis can develop at any age and affect any person; however, it is more common in:

• People of 30 to 60 years of age
• Current and prior smokers
• Individuals who were designated female at birth
• People with a family history of the disease

Early symptoms of rheumatoid arthritis

Symptoms of rheumatoid arthritis may vary in frequency and intensity and may progress at different rates amongst affected people.

Furthermore, individuals with rheumatoid arthritis may experience periods of remission where they don’t experience any symptoms, alternating with periods where the symptoms flare up, usually as the result of stress or infectious diseases like the flu.

The most common signs and symptoms of rheumatoid arthritis at early stages include:

Joint pain and stiffness

Morning stiffness and joint pain are usually symmetrical, meaning pain in the same joint on both sides of the body. For instance, both shoulder joints, knees, or wrists. This is one of the hallmarks of rheumatoid arthritis.

However, in the early stages of the disease, the pain may happen asymmetrically (only on one side of the body), and the most commonly affected joints are the small joints of the hands and feet.

Swelling and warmth in the joints

Joint swelling is common in people with rheumatoid arthritis, and this can be more noticeable in smaller joints, such as in the hands and feet.

Other common symptoms include a sensation of warmth and tenderness in the affected joints.

Fatigue and other general symptoms

Excessive tiredness (fatigue) unrelated to day-to-day activities or physical exertion, weight loss, and fever are common signs and symptoms that may appear at the early stages of rheumatoid arthritis.

Advanced symptoms of rheumatoid arthritis

When left untreated, rheumatoid arthritis may evolve and cause chronic (long-term) pain and other health complications, such as:

Irreversible joint damage

As the disease progresses, larger joints are more frequently affected, including the joints of the shoulders, elbows, wrists, knees, ankles, and hips.

When left untreated, chronic inflammation in your joints can lead to permanent joint tissue damage and subsequent loss of functionality.

Furthermore, joint deformity and erosion of the bone area are also common findings in advanced forms of rheumatoid arthritis.

Systemic symptoms

Being an autoimmune inflammatory disease, rheumatoid arthritis can cause not only damage to the joints but also to other organs and tissues in the body over time, including your:

Depending on the severity of the disease, and the affected organs and tissues, systemic signs and symptoms may vary, ranging from skin nodules (solid, raised bumps in the skin), dry eyes, dry mouth, and anemia (low red blood cell count), to life-threatening health complications such as hardened blood vessels and heart failure.

Rheumatoid arthritis diagnosis and treatment options

Early diagnosis and treatment are imperative to slow the disease progression and prevent long-term damage and loss of functionality in the joints.

Rheumatology is the branch of medicine that takes care of people who have rheumatoid arthritis and other diseases and conditions that affect the joints.

Rheumatoid arthritis diagnosis

The first step to diagnosing rheumatoid arthritis is performing a comprehensive medical evaluation.

This is done by a rheumatologist, who will also order a few tests to determine whether you have the disease. These tests may include:

• Blood tests. Blood tests look for inflammation markers and compounds called autoantibodies, which can indicate the presence of rheumatoid arthritis. Other blood tests that can be included in the initial and successive assessment of rheumatoid arthritis include a complete blood count, liver function tests, and kidney function tests.
• Imaging tests. These include X-rays, ultrasounds, computed tomography (CT), and magnetic resonance imaging (MRI) scans. These tests can show signs of joint deterioration and deformity, as well as bone erosion at advanced stages of the disease. However, during the early stages of rheumatoid arthritis, no signs of joint damage may appear in some imaging tests.

Rheumatoid arthritis treatment

Once the diagnosis has been established, getting early treatment is of utmost importance to avoid further joint damage and possible health complications. Common treatments may include:

Disease-modifying antirheumatic drugs (DMARDs)

DMARDs are the cornerstone of rheumatoid arthritis treatment, and it has been determined that there is a 2-year 'window of opportunity' after diagnosis within which these drugs are more effective.

The main goal of DMARDs is to achieve inflammation control. The first-line treatment is a drug called methotrexate, but other options like leflunomide (Arava®), hydroxychloroquine (Plaquenil®), or sulfasalazine (Azulfidine®) are also available in case methotrexate is contraindicated or not tolerated.

If none of the drugs used for first or second-line treatment work, your rheumatologist may indicate treatment with biologic DMARDs (made of proteins).

Biologic DMARDs include tumor necrosis factor (TNF)-inhibitor drugs, such as adalimumab (Humira®), certolizumab (Cimzia®), etanercept (Enbrel®), or golimumab (Simponi®), among other biologic drugs.

NSAIDs and corticosteroids

Achieving pain control is another important aspect of treating rheumatoid arthritis, as this will improve the individual’s quality of life.

Drugs that can be useful to achieve this goal include nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin®, Advil®) or naproxen (Aleve®).

Besides NSAIDs, other drugs that can be useful for short-term management of pain and inflammation are corticosteroids like prednisone or cortisone, which can be administered orally, intramuscularly (injected into muscles), or intra-articularly (injected into joints).

Non-pharmacological treatment

Physical therapy aimed to improve mobility of the joints, along with low-impact exercises like yoga, swimming, or cycling, can help improve rheumatoid arthritis symptoms.

Furthermore, leading a healthy and active lifestyle and having a balanced diet can help you achieve or maintain a healthy weight, which is important to reduce the strain on your joints.

Surgery

Joint replacement surgery can be used as a last alternative to regain mobility in case of advanced rheumatoid arthritis when all previous treatments have failed and the joint is severely damaged.

In conclusion, with timely diagnosis and treatment, symptoms of rheumatoid arthritis can be managed, and joint damage and other health complications can be prevented.

So, if you have a close relative (parent, sibling) who was diagnosed with rheumatoid arthritis, or if you are experiencing joint pain, morning stiffness, or other symptoms that make you think you may have this disease, seek medical advice from your trusted healthcare provider.