Rheumatoid Arthritis Explained: Symptoms, Stages, Diagnosis & Management

by Dr. I. Rajendra Vara Prasad | May 08, 2025 | Rheumatology | 0 6

7. Seeking Appointment

8. Conclusion

Rheumatoid arthritis (RA) is an autoimmune illness that affects the joints and causes damage to the lining of the joint. The person with RA experiences pain, inflammation, and swelling in the affected joints. This RA is different from osteoarthritis because it includes other systems of the body as well, such as skin, eyes, lungs, heart, and blood vessels, apart from joints. Continuous understanding of the cause and the early symptoms, followed by the process of diagnosis and treatment, is essential for people living with RA in order to maintain their quality of life.

Rheumatoid Arthritis Symptoms

The symptoms of rheumatoid arthritis may worsen over time, affecting additional joints and possibly other organs. The severity and range of symptoms can differ greatly from person to person. Rheumatoid arthritis frequently manifests as

Severe joint pain, swelling, and stiffness: These symptoms may become chronic and can involve larger joints like the knees, elbows, shoulders, and ankles, as well as smaller joints.
Limited range of motion: Inflammation and damage to the joint structures can restrict full movement of the affected joints.
Joint deformities: Chronic inflammation damages cartilage, bone, ligaments, and tendons over time, leading to joint deformities, which usually occur in the hands and feet (such as ulnar deviation of fingers, swan neck and boutonniere deformities, and hammer toes).
Rheumatoid nodules: Firm lumps that sometimes develop under the skin in the vicinity of the elbow or fingers and can also develop in other body parts, including internal organs such as the lungs and heart.
Fatigue and malaise: Persistent fatigue, lack of energy, and a feeling of being unwell are common and can be exhausting.
Dry eyes and dry mouth (Sjögren’s syndrome): The autoimmune condition that affects moisture-producing glands, secondary Sjögren’s syndrome, may also be associated with RA.
Eye inflammation (episcleritis, scleritis, uveitis): Inflammation of any portion of the eye resulting in pain, redness, and visual impairment.
Lungs (pulmonary fibrosis and pleuritis): Inflammation of lung parenchyma and lining may cause shortness of breath and chest pain.
Heart (Pericarditis and increased risk of cardiovascular disease): RA aggravates inflammation around the heart and rapid atherosclerosis development.
Anemia: A low red blood cell count (anemia) is commonly seen in people with RA and further contributes to fatigue.
Carpal tunnel syndrome: Swelling in the wrist region can compress the median nerve, resulting in numbness, tingling, and pain in the hand.

Early Signs and Symptoms of Rheumatoid Arthritis

Recognition of signs early is very crucial for allowing diagnosis and treatment at a very early stage and helps in reducing the disease’s advancement and joint damage. Although described above, the following are the early signs of rheumatoid arthritis that may appear:

Fatigue: Relentless and overwhelming tiredness
Joint Pain: Soreness of one or several joints of a throbbing or aching type.
Joint Stiffness: Prolonged stiffness in affected joints, particularly in the morning or after lapses of activity.
Joint Swelling: When the lining of the joint is swollen as a result of inflammation, joints feel puffy and sore to the touch.
Joint Tenderness: Tenderness and pain at affected joints will be for the touch or movement.
Symmetry of Symptoms: Symmetrical signs are usually common. RA will usually affect joints on both sides of the body at the same time.
Low-Grade Fever: During the times of disease activity increase, a mild, chronic low-grade fever might be present.
Unexplained Weight Loss: There may also be unintentional, body inflammatory responses leading to unexplained weight loss.

Rheumatoid arthritis Symptoms

Understanding Disease Progression

The flow, however, may differ from one individual to another, but usually, it progresses in four stages, which could be generalized:

Inflammation of the synovium; swelling of the joint lining leads to pain, stiffness, and warmth. No X-ray evidence of bone damage at this stage.
The synovium continues to thicken, which damages the cartilage—the smooth tissue at the end of bones in a joint—under which pain, stiffness, and reduced range of motion may be associated. Early X-rays may begin to exhibit some evidence of cartilage damage.
Inflammation and destruction extend to the bone of the joint. Erosion of cartilage and bone damage become more extensive, adding some pain and swelling and reduced mobility, as well as deformities in the affected joint. Bone and cartilage destruction shall be proved clear on X-ray evidence.
Although inflammation may cease, considerable damage has already been done to the joints, leading to restriction of joint function, instability, and often a solidification of the bones in the joint (ankylosis). There is much pain, stiffness, and disability.

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Rheumatoid Arthritis Causes

The exact cause of rheumatoid arthritis is unknown, but it is thought to involve a complex interaction of genetic, environmental, and hormonal factors. As it is an autoimmune disease, this means that the immune system, which usually protects the body from various foreign invaders—microorganisms such as bacteria and viruses—begins to attack healthy tissues by mistake.

Genetic Predisposition: There are certain genes, particularly HLA-DRB1, that confer a susceptibility to this disease. Nevertheless, the presence of these genes does not ensure that RA will develop.
Environmental Triggers:
- Infections, smoking, air pollution, and other such exposures are possible triggers.
- Cigarette smoking has been specifically implicated as a risk factor for RA, particularly strong in cases involving severe disease with poor treatment response.
- Air pollution exposure has also been identified as an increased risk for autoimmune diseases such as rheumatoid arthritis.
- Various industrial exposures, for example, silica dust, have been incriminated.
Hormonal Influences: Since rheumatoid arthritis is more common in females, hormonal factors influence the development or progression of this disease.

Rheumatoid Arthritis Diagnosis

Diagnosis of rheumatoid arthritis has its challenges, especially in the early stages where a simple test will not be able to arrive at a definitive answer. The diagnosis stems from many intertwined issues:

History and Physical Examination: The doctor will ask numerous detailed questions about symptom onset, duration, pattern of occurrence, and family history of autoimmune diseases. A thorough examination will check the joints for swelling, tenderness, warmth, and range of movement.
Blood Tests: A series of blood tests support the diagnosis of RA and assess the activity of the disease.
- Rheumatoid Factor (RF): This antibody is found in the blood of many people with RA but is nonspecific to it; it can be found in other autoimmune diseases and even among a few healthy persons.
- Anti-Cyclic Citrullinated Peptide (Anti-CCP) Antibodies: These are more specific for RA than RF and are likely to be present very early in the disease. A positive anti-CCP test is thus a very strong predictor of RA.
- Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP): Non-specific markers of inflammation in the body that are usually elevated during active RA.
- Complete Blood Count (CBC): A CBC can check for anemia, which is common in RA.
Imaging Tests: Imaging studies assist in visualizing joint damage and monitoring disease progression.
- X-rays: They seldom demonstrate changes in early RA; however, in later stages, erosion of joints as well as narrowing of joint spaces is made evident.
- Ultrasound: This can detect early pathologic abnormalities like synovitis (manifested by inflammation of the joint lining) and erosion of the joints.
- Magnetic Resonance Imaging: MRI gives a more detailed view of soft tissues and can find early inflammatory changes and bone injury that may not be visible on X-rays.
Joint Aspiration (Arthrocentesis): At times, fluid collected from the abnormal joint may be studied in an effort to rule out other potential causes of arthritis through this procedure, such as infection or gout.
Other relevant investigations will be done before starting medicines to assess the safety profile of the patient.

Note: The European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) have created classification criteria for RA that aid medical professionals in diagnosing the disease by taking into account both laboratory and clinical data.

Rheumatoid Arthritis Treatment

Rheumatoid arthritis does not have a cure, but treatment has significantly improved outcomes. Goals are to reduce pain, slow joint destruction, improve physical function and mobility, and prevent long-term complications in spite of great progress in treatment. A typical treatment strategy has medications, therapies, and surgery.

Medications:

Nonsteroidal Anti-inflammatory Drugs (NSAIDs): The agents reduce pain and inflammation.
Corticosteroids: These agents act quickly to provide immediate relief and can offer long-term benefits if used appropriately in the initial stages of the disease under expert guidance; their potential for misuse is significant. Patients often abuse them for their short-term effects, which has unfortunately given these drugs an undeserved bad reputation.
Disease-modifying antirheumatic drugs (DMARDs): These drugs slow the disease and prevent joint damage.
Biologic DMARDs: These are genetically engineered proteins and target any part of the immune system that promotes inflammation.
Targeted Synthetic DMARDs (JAK Inhibitors): Newer drugs block enzymes that form part of the inflammatory pathway. These are good alternatives to biologic DMARDs, which can be taken as tablets. Medicines currently available in India are tofacitinib and baricitinib.

Rheumatoid Arthritis Therapies:

Physical Therapy: Exercises sustain joint mobility and help develop the strength of surrounding muscles while at the same time reducing pain.
Occupational Therapy: It teaches strategies for protecting the joints while carrying out daily jobs.
Assistive Devices: Canes, walkers, splints, and other devices can help reduce stress on joints and improve function.

Surgery:

Biologics has changed the landscape of treatment of RA reducing the number of patients requiring surgeries, but there are instances in which surgery is needed to repair an injured joint, alleviate pain, or even improve function. Some types of surgeries include joint replacement surgery (arthroplasty), synovectomy (removal of the inflamed lining of a joint), joint fusion, osteotomy, and tendon repair.

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Rheumatoid Arthritis Prevention

Genetic factors play a significant role in rheumatoid arthritis (RA). Certain lifestyle changes and management of risk factors might help in preventing or at least delaying the onset of the disease. Here are ten strategies for some potential preventive measures:

Don’t Smoke: Smoking has a strong correlation with a heightened risk of getting RA and potentially exacerbating the disease.
Healthy Weight: While carrying an extra load due to obesity might just put extra strain on the joints—facilitating inflammation—keeping a healthy body weight through diet and exercise may somehow be able to reduce your risks.
Balanced Diet: No diet can stop RA completely. However, a balanced diet with lots of fruits, vegetables, and omega-3 fatty acids could be anti-inflammatory.
Control Gut Health: New research shows that gut bacteria may be involved in the etiology of autoimmune diseases. Including probiotics and prebiotics in the diet to establish a healthy gut microbiome may help.
Maintain Oral Health: Some studies show the relationship of increased risk for RA with periodontitis. So brushing, flossing, and regular dental checkups are essential.
Stress Management: Long-term stress may lead to inflammation in the body. Engaging in stress-reducing methods such as yoga, meditation, or deep breathing exercises might prove beneficial.
Vitamin D and Its Count: Some studies bring up a slight point in that regard, but it is not very conclusive yet that low serum vitamin D levels are linked with increased risk of autoimmune diseases.
Minimize Environmental Pollution: There may be some environmental connections with regard to the development of RA. Reducing exposure to all types of pollution and some specific chemicals appears to be beneficial.

When to seek a medical appointment?

One should schedule a medical appointment if one experiences any of the following:

Persistent joint pain, especially in multiple joints
Prolonged morning stiffness, indicating inflammatory arthritis
Swelling, warmth, and redness in one or more joints
Tenderness to the touch in joints
Symmetrical joint involvement affecting the same joints on both sides
Persistent, unresolved fatigue
Low-grade fever accompanying joint symptoms
Other unusual symptoms affecting joints or overall well-being

Early diagnosis and treatment are crucial for effective management and improved quality of life.

Conclusion

To sum up, rheumatoid arthritis is a multifaceted autoimmune condition with a wide range of symptoms. Effective management of the condition requires knowledge of its causes, early detection of symptoms, prompt diagnosis, and participation in an extensive and individualized treatment plan. People with rheumatoid arthritis can work toward a higher quality of life and lessen the long-term effects of this chronic illness with the help of medical therapy advancements and a proactive approach to self-care.

Yashoda Hospitals in Hyderabad offer comprehensive treatment for rheumatoid arthritis. From precise diagnosis using cutting-edge imaging and specialized lab testing to individualized treatment plans, our multidisciplinary team of skilled rheumatologists, surgeons, physical therapists, and other medical specialists provides a wide range of services.

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