Rheumatoid arthritis (RA) usually starts in the small joints of your hands and feet. As the disease progresses, it could move to your wrists and knees. Though less common, it may also affect your elbows, shoulders, and hips.
Rheumatoid arthritis (RA) is an autoimmune, inflammatory disease that can affect your joints. RA can be a progressive disease and increase in severity over time. It’s possible to have damage to your joints build up over time and not be aware of it.
In this article, we’ll review the joints that RA affects the most. We’ll also describe the symptoms of joint damage and explain when it makes sense to contact a healthcare professional.
If you have RA, the lining of your joints (synovium) becomes inflamed. Over time, this thins the cartilage meant to protect your joints and the ends of your bones.
RA typically starts to affect several joints at the same time, but you may not be aware of the ongoing damage in certain parts of your body. There can be “silent inflammation” that occurs for months or years without much pain.
The most commonly affected areas are:
The small joints of your hands are among the first that RA affects. If you have this condition, you’ll probably notice symptoms such as morning stiffness in both hands.
RA most commonly affects the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in your hand. Your MCP joints are where your hand bone meets your finger bones. Your PIP joints are the first joints of your fingers (your middle knuckles).
- throbbing or aching pain, especially in the morning or after long periods of not moving
- stiffness that makes it hard to make a fist or bend your fingers
- the appearance of rheumatoid nodules (hard areas of swelling) on your fingers, knuckles, and elbows
- feelings of heat and tenderness on and around your joints
- visible deformity as the disease progresses
Feet and ankles
Along with your hands, the small joints of both feet are among the first to feel the effects of RA. As the disease progresses, it may also affect your ankle joints.
Symptoms may include:
- pain and tenderness
- joint deformities such as claw toe, bunions, and hammer toe
- osteopenia and stress fractures
- trouble with balance
- difficulty walking stairs and up inclined surfaces (when your ankles become affected)
- difficulty walking and standing
- changes in the shape of your feet, such as flat foot deformity
- rheumatoid nodules on the backs of your heels
Your wrist comprises several smaller joints, including your radiocarpal and midcarpal joints. Along with your hands, wrist involvement is very common in RA. Since this disease affects your body symmetrically, both wrists will experience symptoms, including:
- joint pain
- redness and warmth in and around your joints
- grinding or clicking sounds
- weakness and difficulty holding items
- decreased range of motion
- visible deformity
RA typically affects both knees during stage 1 (synovitis). Early knee symptoms include joint pain, stiffness, and a feeling of warmth around your joint.
As the disease progresses, additional symptoms may occur, especially if you don’t get treatment. They include:
- locked knees
- bone pain
- difficulty walking and standing
- clicking or popping noises
In addition to pain, you may experience stiffness and swelling. These vertebrae support your head and help control its movement, so you may also have difficulty moving your head.
Headaches may often accompany neck pain with RA. Known as cervicogenic headaches, these may feel like migraine or cluster headaches, but they have different causes. Migraine and cluster headaches start in your brain, but cervicogenic headaches start in your cervical spine.
Not everyone with RA will have it progress to their shoulders. If you experience RA symptoms in your shoulders, you may have advanced RA disease.
The two shoulder joints RA is most likely to affect are your acromioclavicular (AC) and glenohumeral joints. Your AC joint is where your collarbone connects with the tip of your shoulder blade. Your glenohumeral joint is where the top of your upper arm bone fits into your shoulder blade.
Symptoms of RA in your shoulders include:
- pain or tenderness, which may get worse during or after physical activity
- feeling of warmth
- reduced range of motion
- crepitus (cracking, popping, or grating sounds in your joint)
- frozen shoulder
- degenerative tears in your rotator cuff
RA may affect your hips as it progresses. In later-stage RA, inflammation can break down the cartilage in your hip joints, causing symptoms such as:
- pain, stiffness, or swelling in your hips, groin, buttocks, and thighs
- trouble walking and standing
- limited range of motion
RA is less common in your elbows than it is in other joints. But pain from RA in this area of your body is likely to become severe as the disease progresses.
Symptoms of RA in your elbows include:
- pain that can be intense
- loss of function of your elbow
- severe area of swelling in or near your elbow
- stiffness or locking of your elbow
- a sensation of pins and needles caused by nerve damage
- rheumatoid nodules
Rarely, RA can affect the joints in the lumbar spine of your back. While there’s some debate, RA may cause inflammation of your
RA affecting the facet joints in your back can cause tenderness at the site of your joints and pain that worsens when you try to stretch or rotate your torso.
You may not think that a disease that affects your joints could have an impact on your
RA is a progressive disease, meaning it may worsen over time. You typically experience symptom flares that come and go.
The smaller joints in your body are usually the first to experience symptoms such as pain and stiffness. These are the joints that connect your fingers to your hands and your toes to your feet.
As RA progresses, inflammation and the erosion of cartilage may spread farther inward to your:
- wrists and ankles
- knees and elbows
- hips, neck, and shoulders
Not everyone with RA will experience the same set of symptoms. But RA tends to affect the same joints on both the right and left sides of your body.
Let a healthcare professional know of any changes, either sudden or gradual, that affect your joints. These include:
- stiffness when you wake up
- areas of warmth
The early symptoms of RA can look like several other conditions, including osteoarthritis. Early diagnosis and targeted treatments can help you maintain mobility and reduce pain. Early diagnosis may also help you avoid the symptoms associated with later-stage RA disease.
Discuss your symptoms with a healthcare professional who can provide clarity about your diagnosis and what to expect.
Resources for support
- Visit Healthline’s Rheumatoid Arthritis Resource Center.
- Connect with other people who have RA at Bezzy RA.
- View resources from the American College of Rheumatology.