Does Rheumatoid Arthritis Run in the Family?

Early Signs & Symptoms of Rheumatoid Arthritis

Early symptoms of rheumatoid arthritis come on gradually, often before joint pain or stiffness is noticeable, and may include:

• Fatigue
• Muscle pain
• Low-grade fever
• Weight loss
• Numbness and tingling in the hands
• Feeling unwell (malaise) 

Joint pain and stiffness usually starts in the small joints, such as those of the fingers or toes, or may occur in a single, large joint, such as the knee or shoulder, or it may shift from one joint to another.

Symptoms of Progressing Rheumatoid Arthritis

Rheumatoid arthritis tends to affect the same joints on both sides of the body (symmetrical). As the condition progresses, joint pain and inflammation become more pronounced and symptoms include: 

• Joint pain and stiffness that may affect the:
  • Hands
    • May result in carpal tunnel syndrome, which causes weakness, tingling, and numbness in the hand and fingers
    • Finger deformities/bent fingers 
  • Wrist: difficulty bending the wrist backward
  • Elbow: swelling in elbow may result in numbness or tingling in the fingers
  • Shoulder: pain and limited motion
  • Foot: tenderness at the joints at the base of the toes that may cause one to stand and walk with weight on the heels. The top of the foot may be swollen and red, and the heel may be painful.
  • Ankle: may cause nerve damage, leading to numbness and tingling in the foot
  • Knee: difficulty bending the knee and "Baker's cyst" (a fluid-filled cyst in the space at the back of the knee)
  • Hips: difficulty walking
  • Neck: painful and stiff neck, difficulty bending the neck and turning the head
  • Cricoarytenoid joint: inflammation of a joint near the windpipe that can cause hoarseness and difficulty breathing
• Other symptoms of rheumatoid arthritis may include:
  • Bone loss: decreased bone density
  • Muscle weakness 
  • Skin problems: rheumatoid nodules (painless lumps that appear beneath the skin) 
  • Eye problems: eye redness, pain, and vision problems
  • Lung disease: shortness of breath and a dry cough
  • Pericarditis: inflammation of the tissue around the heart that can cause chest pain and difficulty breathing
  • Vasculitis: inflammation of the blood vessels
  • Sjögren's syndrome: causes dry eyes and dry mouth

The diagnosis of rheumatoid arthritis involves a combination of clinical, laboratory, and imaging information. 

Laboratory studies used to diagnose rheumatoid arthritis include:

• Rheumatoid factor (RF) assay 
• Anti-cyclic citrullinated peptide (anti-CCP) and anti-mutated citrullinated vimentin assays 
• Erythrocyte sedimentation rate 
• C-reactive protein level 
• Complete blood count 
• Antinuclear antibody assay 

Imaging studies used to diagnose rheumatoid arthritis include:

• X-rays (first choice): Hands, wrists, knees, feet, elbows, shoulders, hips, cervical spine, and other joints as indicated 
• Magnetic resonance imaging (MRI): Primarily cervical spine
• Ultrasound of joints: Joints, as well as tendon sheaths, changes and degree of vascularization of the synovial membrane, and even erosions

Joint aspiration and analysis of synovial fluid may also be indicated.