Some symptoms of rheumatoid arthritis (RA) are the direct result of damage to the joints, while others are due to the widespread effects of an overactive immune system.
Fever and Fatigue
A low-grade fever (under 100° F) and extreme fatigue four to six hours after waking up are two of the earliest symptoms of RA and may occur before any joint pain or swelling. Because these symptoms are also associated with more prevalent diseases, such as the seasonal flu and the common cold, many patients overlook them.
Joint Pain and Swelling
These symptoms usually begin in the smaller joints first, particularly in the fingers and wrists, with pain and swelling affecting the hands. Other joints that may experience pain and swelling are the ankles, knees, hips, elbows, shoulders, neck and jaw. Affected joints may feel warm and spongy to the touch. Joint inflammation is almost always symmetrical on both sides of the body — meaning, for example, that if your left hand is affected, your right hand will be as well.
One symptom that helps distinguish rheumatoid arthritis from other forms of arthritis is prolonged stiffness of the joints (lasting an hour or more) upon waking in the morning or after a long period of inactivity, such as sitting or lying down.
Read about other causes of joint stiffness.
In more advanced RA, hard, flesh-colored lumps called rheumatoid nodules may appear under the skin of the arms, hands, and elbows. They can range from pea-size to walnut-size, and can be movable or firmly connected to tendons under the skin.
Other RA Symptoms
The symptoms below are less common, and are associated with more severe or further advanced rheumatoid arthritis.
Dry Mouth and Eyes
Rheumatoid arthritis is often associated with Sjögren's syndrome, a condition in which the immune system attacks the salivary glands and tear ducts. This can cause a dry or gritty sensation in the eyes, mouth, and throat; cracked or peeling lips; and difficulty talking or swallowing.
Learn about other causes of pleurisy.
Severe joint damage can cause the hands and fingers to bend at unnatural angles, causing them to look gnarled and twisted and inhibiting movement. This can also affect the wrists, elbows, ankles, and knees.