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Rheumatoid arthritis (RA) is an autoimmune disease that affects the joints. In autoimmune diseases, the immune system can attack healthy tissue in the body for unknown reasons.

With RA, the immune system attacks the lining of the joints, which causes the joints to become inflamed, swollen, and painful. However, RA is systemic, meaning it can affect other areas of the body in addition to joints.

According to the Arthritis Foundation, about 1.5 million Americans have RA, and three times as many women as men are affected by the disease.

Listen to your body’s clues for symptoms of RA.

RA is often thought to be a condition related to old age, but this is not the case.

According to the Arthritis Foundation, the average onset of RA is between the ages of 30 and 60 years old, and children can also get it.

Women tend to be diagnosed slightly earlier than men, potentially due to hormonal changes in the mid-30s and then again after the mid-40s.

RA is a chronic condition that can progress over time with periods of increased disease activity, called flares, and periods of remission.

Symptoms of RA vary from person to person depending on the severity of their condition.

Not only do more women get RA than men, but they also tend to experience symptoms at a younger age which may be more severe.

Remission in the early stages of the disease, where symptoms don’t occur, also tends to be less prevalent in women. Researchers have been trying to find out why.

The reproductive hormones estrogen and progesterone seem to potentially have a protective effect against symptoms of RA.

The levels of various hormones in the body change throughout a woman’s lifetime. Factors that can affect these levels include:

Hormones used in in-vitro fertilization (IVF) treatment could also be a trigger.

An older study on a small group of middle-aged women with RA found that they reported fewer joint symptoms during post-ovulation in their menstrual cycles and also during pregnancy. This is when levels of estrogen and progesterone are higher.

Medical experts tend to agree that the effect of sex hormones combined with environmental and genetic factors could explain the higher prevalence of women diagnosed with RA.

Research continues to seek more answers.

As mentioned, RA isn’t only a disease for older people.

According to the CDC, the diagnoses in the United States of all types of arthritis from 2013 to 2015 are as follows:

Age rangePercentage ever diagnosed
18 to 44 years7.1%
45 to 64 years29.3%
65 years and older49.6%

During the same years, 26 percent of women and 19.1 percent of men have ever reported a diagnosis of arthritis, of which RA is a subset.

Prevalence of the disease increases with age, nearing 5 percent in women over age 55 years.

General, non-joint early symptoms of RA include:

  • fatigue
  • low-grade fever
  • loss of appetite
  • unintentional weight loss

These signs can precede the painful joint symptoms commonly associated with RA.

Recurrent bouts of fatigue along with a general sense of not feeling well may occur weeks or months before other symptoms.

As the disease progresses, these symptoms may accompany joint-related symptoms during a flare.


Morning joint stiffness is a strong indication of RA.

Joint stiffness usually lasts anywhere from 1 to 2 hours and sometimes longer. It can also occur after prolonged periods of rest or inactivity such as napping or watching television.

Stiffness and decreased range of motion can eventually make simple daily tasks such as buttoning a shirt or opening a jar difficult.

Joint swelling and pain

When the disease is active, affected joints become red, swollen, painful, and feel warm to the touch.

In the early stages of RA, smaller joints in the hands, wrists, and feet tend to be affected first. Over time, larger joints in the knees, shoulders, hips, and elbows may become affected.

What differentiates RA from other types of arthritis is that RA symptoms attack symmetrically. This means that if your left wrist is inflamed, your right wrist likely will be inflamed as well.

Rheumatoid nodules

According to the Johns Hopkins Arthritis Center, 20 to 30 percent of people with RA develop rheumatoid nodules, firm lumps of tissue that grow under the skin at bony pressure points.

Rheumatoid nodules are most often found on elbows, but they can be found on other areas of the body, such as on the fingers, over the spine, or on the heels. They’re usually painless and can appear alone or in clusters.


Chronic inflammation caused by RA over the long term may cause damage to bone, cartilage, tendons, and ligaments.

In advanced stages, RA can lead to extensive bone erosion and joint deformity. A telltale sign of severe RA is twisted fingers and toes bent at unnatural angles.

Severely disfigured hands can impair fine motor skills and make performing daily tasks challenging. Deformity can also affect wrists, elbows, knees, and ankles.

Symptoms throughout the body

In severe cases of RA, persistent inflammation may affect other areas of the body, such as the eyes, lungs, heart, and blood vessels.

Long-term inflammation may cause:

  • severe dry eyes and mouth (Sjögren’s syndrome)
  • rheumatoid inflammation of the lung lining (pleurisy)
  • inflammation of the covering of the heart (pericarditis)
  • reduction of the number of healthy red blood cells (anemia)
  • a very rare yet serious blood vessel inflammation that can limit blood supply to tissues, leading to tissue death (vasculitis)

RA in women is not an uncommon disease and an increased prevalence seems to be linked in hormonal, genetic, and environmental factors, though understanding continues to evolve.

Other sex-related factors such as pain severity and a lag time in diagnosis in women are also being researched.

If you’re experiencing any symptoms of RA, especially if you’re a woman, talk with your doctor.

They may refer you to a rheumatologist, a doctor who specializes in diseases that affect the joints, connective tissues, and a range of autoimmune diseases.