What flares up arthritis?

RA Symptoms: How Do You Diagnose Rheumatoid Arthritis?

Matthew Ezerioha, MD

Doctor of Medicine (M.D.) in 2016 from Medical University of South Carolina, Expert Medical Consultant & Entrepreneur

Oct 27, 2018 7 min read

Rheumatoid arthritis (RA) symptoms range from obvious physical symptoms of joint damage and joint deterioration to less obvious signs and symptoms that mimic other illnesses. This is what makes rheumatoid arthritis so difficult for healthcare providers when it comes to diagnosing and prescribing treatment, especially in its early stages.

Common Rheumatoid Arthritis Symptoms

Symptoms experienced by rheumatoid arthritis patients are a direct result of the inflammation of joint tissue and/or accumulation of synovial fluid caused by this autoimmune disorder.

An autoimmune disorder is a disease in which the body’s immune system attacks healthy tissue, mistaking it for foreign or damaged tissue. Though there are many types of autoimmune diseases, such as multiple sclerosis (MS) and systemic lupus erythematosus, rheumatoid arthritis is one that afflicts roughly 1.5 million Americans.

Symptoms of RA can range from mild to debilitating, and every level in between. However, there are some common overall symptoms to be aware of should you suspect that you or someone you know is suffering from rheumatoid arthritis.

Below are the most commonly reported rheumatoid arthritis symptoms:

Joint Pain & Tenderness

Typically, joint pain is felt during times when the disease is active and the inflammation is irritating the joint, ultimately causing the pain (as opposed to diseases like osteoarthritis in which the pain comes from wear and tear on the joints).

Conversely, pain can also be felt when the disease isn’t active because of past damage that has been done to the joints in the body. This is similar to pain from old sports injuries in the elbows, knees, and other joints.

In addition to outright pain, RA patients may also notice that their joints feel tender to the touch. This occurs when the inflammation in the joint tissue has affected the nerves within the joint capsule. In this case, any pressure placed on the joints—even slight compression during sleep—can elicit immediate pain.

Pain and tenderness may be felt if arthritic disease has settled into the bones in the cervical spine — the vertebrae in the neck area of the spinal cord, or more specifically in the atlanto-axial joint (the joint between the first two cervical vertebrae).

It is the pain associated with RA that sends many patients in search of effective treatment options. Fortunately, there are quite a few—many of which include nonsteroidal anti-inflammatory drugs (NSAIDs) or disease-modifying antirheumatic drugs (DMARDs)— providing RA patients some much-needed pain relief.

Joint Swelling

Joint swelling is another common RA symptom expressed by patients with this disease and it is caused by inflammation in the joint capsule. The amount of swelling experienced by RA patients can range from limited to very profound.

Joint swelling due to inflammation can reduce mobility and range of motion for people with rheumatoid arthritis. If the inflammation affects joints in the hands and fingers, it can make it difficult to perform daily tasks such as putting on clothes or removing rings from fingers. Anti-inflammatory drugs can sometimes help reduce the swelling that results from RA.

Joint Redness & Warmth

When joints are swollen due to RA, it can sometimes produce an isolated area of redness on the skin. This is because the skin’s capillaries widen due to the inflammation within the joint capsule, making them more visible.

Additionally, when joints have become inflamed as a result of this disease, it is possible to feel warmth on the joint even if no redness is occurring. That’s why it’s important to pay attention to how your body feels as some RA’s symptoms aren’t noticeable to the eye.

Joint Stiffness & Loss of Range of Motion

Stiffness in the joints occurs when this disease is in an active state of inflammation, or when your immune system is actively attacking healthy tissue. Oftentimes, the greatest amount of stiffness occurs in the mornings, but it can continue throughout the day as well.

Dealing with this type of stiffness, as well as overall joint swelling, can result in the loss of range of motion if rheumatoid arthritis treatment is not sought early or if the disease is too advanced. In more advanced RA, the range of motion can be permanently lost in certain joints.

Working with a qualified physical therapist may help preserve or extend the range of motion for RA patients. Other treatment methods, such as taking nonsteroidal anti-inflammatory drugs, can help as well.

Joint Deformity

In addition to experiencing pain and early morning stiffness, there are other signs which may indicate damage to the joint. When severe damage has occurred to the joint capsule’s cartilage and bones, the patient’s entire joint can become deformed. This is usually the result of chronic rheumatoid arthritis that has gone undetected and without treatment.

The above symptoms are linked to direct damage to the joints in people with rheumatoid arthritis. However, each symptom can manifest in different ways, throughout different parts of the body, and during different periods of time with this particular immune system-related disease.

There are also some more general symptoms and early warning signs which can often be mistaken for other conditions. These and more are discussed in detail below.

What Areas of the Body are Affected?

Symptoms of joint inflammation caused by rheumatoid arthritis can occur throughout several areas of the body. The nature of autoimmune disease in RA leads to inflammation in multiple joints gradually wearing the bone and cartilage away.

The main areas affected by joint inflammation are:

  • Hands (fingers and knuckles)
  • Wrists
  • Elbows
  • Shoulders
  • Hips
  • Knees
  • Ankles
  • Toes

RA symptoms can occur in either one or multiple locations. When symptoms occur in more than four different joints in the body, the condition is referred to as polyarthritis.

Symmetrical Symptoms

Rheumatoid arthritis is often described as a cause of symmetrical symptoms. This means that pain is felt in joints on the left side of the body, as well as the right. Patients often describe symptoms on both sides of the body to their doctor.

Although the symptoms due to RA are often experienced on both sides of the body, they may progress at different rates on each side. This means that the severity of pain isn’t always symmetrical.

It is a common characteristic of RA that patients report experiencing a different level of pain and discomfort on either side of their body at different times during the day.

Early Rheumatoid Arthritis Symptoms

In the early stages of rheumatoid arthritis, it is common to feel characteristic symptoms of pain and stiffness. The specific symptoms, their severity, and timing differ in each patient and may be related to how aggressively the immune system is attacking the body’s healthy tissues.

Some of the most common RA signs and symptoms include:

  • Pain and tenderness in joints for at least six consecutive weeks
  • Stiffness and loss of range of motion in the joints
  • Stiffness in the morning lasting at least 30 minutes and up to several hours
  • Pain and soreness in one or multiple joints
  • Involvement of joints on both sides of the body
  • Pain and soreness in small joints like knuckles and toes

Early Warning Sings

In conjunction with the early symptoms, there are some serious warning signs that may indicate you are developing rheumatoid arthritis and need to seek treatment. Some of these warning signs include:

  • Sports injuries that don’t heal properly (even after arthroscopic surgery)
  • Ongoing numbness and tingling in hands
  • Swollen forefoot often preventing women from wearing high heels
  • Pain in the heel and bottom of the foot
  • Locked joints that are unable to bend such as the knees and elbows
  • Fatigue, depression or overall feelings of ill health lasting weeks or months

In cases of juvenile rheumatoid arthritis, early warning signs may include swollen lymph nodes or the unexplained appearance of a rash or fever.

Progressive Symptoms

Beyond the typical early signs and symptoms that your immune system may be attacking your own body, other more advanced symptoms of rheumatoid arthritis could include chronic fatigue, loss of appetite, and low-grade fever.

If diagnosed with advanced rheumatoid arthritis or RA that has not received any type of treatment, some patients will develop rheumatoid nodules. These are noticeable firm lumps developing under the skin near the affected joints.

Often times these nodules will appear on the hands and the back of the elbows. However, some RA sufferers even develop nodules in their eyes.

Blood tests revealing high levels of rheumatoid factor can sometimes signal that this particular symptom of rheumatoid arthritis is likely to occur. The test for rheumatoid factor, in combination with tests that measure the degree of inflammation such as erythrocyte sedimentation rate (ESR) or c-reactive protein (CRP) can indicate how aggressive this disease is likely to be.

If the ankles and knees are affected, RA patients may develop a limp to help them reduce the pain derived from bearing the weight of their body on their sore joints.

Because RA inflammation causes the body to release enzymes that damage cartilage and bone, the sooner it is diagnosed and treatment is sought, the less damage it can do over time.

Flare-Ups and Remission

Increased sensitivity due to inflammation is called a flare-up and rheumatoid arthritis’ more severe symptoms are most often felt during this time. Flare-ups can also have different characteristics of pain and discomfort for different people, depending on how aggressively the immune system is working to attack healthy body cells.

Often times, rheumatoid arthritis patients don’t know exactly what causes their flare-ups, although physical activity is a common trigger for the pain and joint stiffness. Additionally, flare-ups can last varying amounts of time for each person. But, sometimes, they are followed by the remission of symptoms.

When inflammation subsides, with or without treatment, this is known as a state of remission. Though the inflammation is limited, pain and stiffness can still often be felt due to the level of damage that’s already been done to the joint.

The frequency of flare-ups may be related to the severity of the autoimmune disease, the amount of joint damage it has already caused, and whether treatment has been initiated.

Other Symptoms

Rheumatoid arthritis can cause less obvious or indefinite symptoms alongside the common physical joint symptoms. Often times, rheumatoid arthritis sufferers seeking treatment will report symptoms that could be mistaken for other illnesses or conditions, such as when they experience flu-like symptoms such as low-grade fever or muscle aches.

In the early stages of rheumatoid arthritis (and beyond), it is common to experience fibromyalgia-like symptoms. But the major difference between these two diseases is that rheumatoid arthritis causes inflammation whereas fibromyalgia does not.

Here are some of the other, mistakable symptoms of rheumatoid arthritis:

  • Eye dryness and pain
  • Light sensitivity and impaired vision
  • Lung inflammation that causes shortness of breath.
  • Blood vessel inflammation that causes damage to the nerves and organs, including skin.
  • Low red blood cell counts, a condition known as anemia.

Of course, on their own, these symptoms could all be the result of any number of different illnesses, some of which are still in the arthritis family, like Sjogren’s syndrome (eye dryness, sensitivity and pain) osteoarthritis, psoriatic arthritis, cricoarytenoid arthritis (arthritis in the cricoarytenoid joint, or larynx) and other types of arthritis.

This is why it is so important to be aware of the most common symptoms of rheumatoid arthritis so that you will be well informed while discussing them with your doctor. This will go a long way to ensure that you receive a proper diagnosis as early as possible.

Can you have flare-ups of osteoarthritis?

An OA flare-up can be treated with medication, lifestyle changes, and home remedies. A combination of the following methods may be necessary:

Medication and medical treatment

Share on PinterestMedication may be prescribed to treat osteoarthritis flare-ups.

Over-the-counter (OTC) and prescription medications can relieve OA symptoms.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to reduce arthritis symptoms.

Those available OTC include:

  • aspirin
  • ibuprofen (Advil, Motrin)
  • naproxen (Aleve)

NSAIDs are a short term solution for joint pain, and if taken for long periods they can cause stomach bleeding.

If OA symptoms are more serious, a doctor may prescribe stronger medications. These include narcotics, prescription-strength NSAIDs, and corticosteroid injections.

Joint replacement surgery may be necessary to resolve symptoms, in severe cases.

Transcutaneous electrical nerve stimulation (TENS)

TENS therapy sends electrical pulses through the skin. The aim is to change the body’s nerve signals and reduce pain. TENS devices are available OTC, or through a doctor or physical therapist.

This therapy cannot slow or reverse joint damage and is only intended to alleviate pain. TENS is not suitable for everyone, and anyone interested in using a device should first speak with a doctor.

Hot and cold therapy

Applying a heating pad or an ice pack can reduce pain and stiffness in the joints. Some people see the best results when they alternate between hot and cold.

Stress management

Managing stress can help to reduce pain during flare-ups and minimize their frequency.

Tips for managing stress include:

  • keeping track of events and situations that increase stress
  • trying cognitive behavioral therapy (CBT), which can help a person learn to approach stressors in a more positive manner
  • practicing stress-busting techniques, such as meditation, mindfulness, deep breathing, and progressive muscle relaxation
  • getting a massage, which can reduce physical pain and emotional stress.
  • regularly getting at least 7 hours of sleep a night

Balance rest and activity

It is important to rest after periods of activity, and resting can be beneficial during an OA flare-up. However, too much rest can prolong the pain.

Whenever possible, try to engage in light activities, such as a short stroll, a gentle swim, or light housework.

Assistive devices

Certain devices can reduce stress on the joints and make life easier for people with arthritis. Helpful products may include jar openers, adaptive cutlery, grabbing devices, and dressing aids.

Frequently Asked Questions (FAQs)

1. What is arthritis?

Arthritis is a general term for conditions that affect the joints or tissues around the joint. There are more than 100 types of arthritis.

Most types of arthritis cause pain and stiffness in and around the affected joint or joints. Some types of arthritis, such as rheumatoid arthritis, also affect the immune system and some internal organs of the body.

Learn more about common forms of arthritis in the Arthritis Types section.

Experts use different definitions to gather information about arthritis in the population. Learn more on the Arthritis Case Definitions page.

2. What are the most common types of arthritis?

The most common form of arthritis in the United States is osteoarthritis. Other common types of arthritis include rheumatoid arthritis, gout, and fibromyalgia. Fibromyalgia is included in arthritis for public health purposes.

3. What are the symptoms of arthritis?

Different types of arthritis have different symptoms. Pain and stiffness in and around one or more joints are common symptoms for most types of arthritis. Depending on the type of arthritis, symptoms can develop suddenly or gradually over time. Symptoms may come and go, or persist over time.

For information about the symptoms of specific types of arthritis, visit our Arthritis Types section.

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4. What causes arthritis?

Experts don’t know the causes of many forms of arthritis. However, we do know that gout is caused by too much uric acid in the body. Sometimes specific infections can also cause arthritis.

Scientists are studying the role of factors such as genetics, lifestyle, and environment in different types of arthritis to learn more possible causes and risk factors.

For information about known arthritis risk factors, visit the Risk Factors page.

5. Am I at risk for arthritis?

Certain factors make it more likely that you will develop arthritis. You can control some risk factors, and others you cannot. By changing the risk factors you can control, you can decrease your risk of getting arthritis or making arthritis worse.

Learn more about arthritis risk factors.

6. Are people with arthritis more likely to develop complications from the flu?

If you have a form of inflammatory arthritis, like rheumatoid arthritis or lupus, you may be more likely to develop complications from the flu than most people.

Flu-related complications may include:

  • Sinus infections.
  • Ear infections.
  • Bronchitis.
  • Pneumonia.

People with inflammatory arthritis are more vulnerable to flu-related complications because they have weakened immune systems. These forms of arthritis and some of the medications used to treat them can both weaken the immune system.

Learn about flu complications and warning signs to look for on the Flu Symptoms and Complications webpage of the CDC Flu website.

7. How many adults in the United States have arthritis?

An estimated 54.4 million US adults have arthritis. Experts believe that number will grow as our nation’s population gets older.

Learn more about arthritis prevalence on the Arthritis-Related Statistics page.

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8. Can children get arthritis?

Yes, children can get arthritis. The most common type of arthritis found in children is juvenile idiopathic arthritis (JIA), also known as childhood arthritis or juvenile rheumatoid arthritis.

Signs and symptoms of childhood arthritis may include:

  • Joint pain.
  • Swelling.
  • Fever.
  • Stiffness.
  • Rash.
  • Fatigue (tiredness).
  • Loss of appetite.
  • Inflammation of the eye.
  • Difficulty with daily living activities such as walking, dressing, and playing.

Childhood arthritis causes permanent damage to the affected joint or joints. Early diagnosis and proper treatment are important to prevent or minimize permanent damage. There is no cure for childhood arthritis, but some children with childhood arthritis achieve permanent remission, which means the disease is no longer active.

Learn more about childhood arthritis.

9. Can I prevent arthritis?

You can reduce your risk of getting some types of arthritis by changing risk factors you can control. Risk factors you can control include overweight and obesity, joint injuries, and smoking.

Learn more about arthritis risk factors.

To treat or not to treat? Managing PsA flares

Dr. Alexis Ogdie, a rheumatologist at the University of Pennsylvania and director of the Penn Medicine Psoriatic Arthritis and the Spondyloarthropathies Program, tackled the topic of psoriatic arthritis flares in a National Psoriasis Foundation webinar for medical providers on May 25.

Sharing insights from research in the field and her own clinical experience, she offered pointers on working with patients on self-care strategies and knowing when it’s time to try more aggressive treatment.

Here are five tips from Ogdie on managing psoriatic arthritis flares.

1. Don’t just focus on the joints.

Citing a 2015 study by lead author Anna Moverly published in the journal Rheumatology, Ogdie urged providers to remember that “a flare of psoriatic arthritis is not limited to the joints.”

Flares aren’t limited to physical symptoms either, Ogdie said.

Pain, heat, stiffness and swelling in the joints can be part of the flare experience, as can worsening skin psoriasis. Other symptoms, such as feeling more tired than usual or not being able to participate in daily activities, can be tougher to recognize.

“Fatigue is clearly a very severe and important symptom that accompanies flare,” she said.

All of these symptoms can occur separately or in combination, according to Ogdie.

“The patient may be flaring in terms of just the skin, or the patient may be flaring in terms of the arthritis, or both,” she said.

2. Make sure it really is psoriatic arthritis.

“Once we assess the patient, the first thing to consider is, ‘Is this person’s increase in joint pain really related to the psoriatic arthritis? Or is it something different?’” Ogdie said.

Other possible explanations Ogdie offered for patients’ symptoms include gout, septic arthritis, fibromyalgia or a musculoskeletal issue.

3. Understand flare triggers.

There is not a lot of data available on what can trigger a psoriatic arthritis flare, Ogdie said. But patients note a number of possible triggers, including stress, changing medication, over-exertion and poor diet.

Lifestyle modifications can be one way to address flares triggered by these factors. For instance, healthy eating, exercise, getting enough sleep and consistently taking their medication can be useful strategies that patients can do on their own to address flares.

“Self-management may include taking a day off work to rest and catch up on sleep, or being diligent about getting a good night’s sleep on a regular basis,” Ogdie said.

4. Recognize when it’s time to turn up the treatment.

Ogdie discussed three types of flares. Flares characterized by an increase in symptoms within a normal variation and short-lived flares caused by an external trigger may be most amenable to self-management, she said.

But the third type, which involves an unprovoked and persistent increase in disease symptoms, may call for more than self-management.

The 2015 GRAPPA Treatment Recommendations and the 2015 EULAR Treatment Recommendations can guide clinicians’ decisions regarding treatment, Ogdie said.

Before making a medication change, doctors should consider all of the disease manifestations a patient may be experiencing, according to Ogdie.

“You want to pick a therapy that’s going to cover as many of their disease manifestations as possible,” she said. These might include axial disease, peripheral disease, enthesitis, dactylitis or other domains.

Clinicians should also consider how often flares are occurring.

Citing a 2015 study of rheumatoid arthritis flares by lead author Dr. Iris Markusse in the journal Arthritis Research and Therapy, Ogdie said that patients who experience more flares over time could be at risk for poorer clinical outcomes.

“A flare every once in a while is not that big of a deal,” Ogdie remarked. “Multiple flares may suggest worse long-term outcomes.”

“That’s probably someone who may need more aggressive therapy,” she said.

5. Don’t delay follow-up.

After patients and providers settle on a management strategy, it’s important for doctors to check back in with their patients soon by phone or through a follow-up visit.

Four to six weeks is a good time for a follow-up check in, Ogdie advised.

Dr. Ogdie’s webinar is available on-demand here.

The National Psoriasis Foundation offers a range of in-person and online continuing education opportunities for medical professionals. For more information, click here.

Rheumatoid Arthritis

  • Surgery for rheumatoid arthritis – introduction
  • Surgery for rheumatoid arthritis – upper limb and neck
  • Surgery for rheumatoid arthritis – lower limb
  • Outpatient clinics for rheumatoid arthritis
  • Complementary and alternative approaches for rheumatoid arthritis
  • Living with rheumatoid arthritis
    • Diet & food supplements for rheumatoid arthritis
    • Exercise for rheumatoid arthritis
    • Personal life and changes to the home for people with rheumatoid arthritis
    • Social life & relationships of people with rheumatoid arthritis
    • Mobility, driving & transport issues for people with rheumatoid arthritis
    • Work and rheumatoid arthritis
    • Financial implications for people with rheumatoid arthritis & financial support
    • Sources of support for people with rheumatoid arthritis
    • Body image and rheumatoid arthritis
    • Attitude to RA & facing the future
    • Self-management of rheumatoid arthritis
    • Ongoing symptoms of rheumatoid arthritis – flares, stiffness & sleep disturbance
    • Ongoing symptoms of rheumatoid arthritis – pain, fatigue, depression, weight change
    • Pregnancy & breastfeeding with rheumatoid arthritis
    • Parenting & childcare with rheumatoid arthritis
    • Messages to others with RA
    • Messages to health care professionals
    • Finding information about RA
  • People’s Profiles
    • Disease duration 0-5 years
    • Disease duration 6-10 years
    • Disease duration 11-15 years
    • Disease duration 16-20 years
    • Disease duration 21-25 years
    • Disease duration 26 years plus
  • Resources and Information
  • Credits
  • About the author

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