Rheumatoid arthritis (RA) is an autoimmune disease where the immune system mistakenly attacks healthy tissues. The exact cause is unknown, but genetics and environmental factors may play a role. The disease primarily affects the joints of the hands, wrists, and knees, though any joint is at risk. Untreated, RA can erode bone, deform joints, and damage other organs such as the skin, eyes, heart, and blood vessels.

Early stage

Early symptoms of rheumatoid arthritis typically involve pain in one joint or in the fingers, wrists, toes, or ankles. The disease is common in people 20-50 years old, but children and older adults can also be affected. RA that begins after 60 years old is called late-onset and is often milder, though it tends to affect larger joints like the shoulders. Initial signs appear gradually, sometimes even before pain and joint stiffness become pronounced. These include:

Fatigue: This is the body's response as inflammation impacts joints and other areas.

Joint swelling: During flare-ups, joints swell due to thickening of the synovial membrane (the lining of the joint) and excess joint fluid.

Pain or stiffness in the same joint on both sides of the body: Symptoms tend to occur symmetrically. When the disease affects multiple joints without symmetry, it is called asymmetric polyarthritis.

Weight loss: If you experience weight loss without intense eating or exercise, consult a doctor for an accurate diagnosis.

Discomfort: A general feeling of illness or weakness can occur as the immune system attacks the body's tissues and joints, causing inflammation, pain, and swelling.

Fever: Patients may develop a fever due to the inflammatory process or antirheumatic medications.

Early stage rheumatoid arthritis often causes pain and stiffness in finger and toe joints. Illustration created by AI

Progressive stages

Rheumatoid arthritis progresses through four stages. In stage 2, swelling is a common symptom. Stage 3 may involve joint deformities and nerve pain. By stage 4, joints are nearly immobile with permanent damage. Progressive symptoms of the disease include:

Reduced range of motion: Balance, coordination, grip, and dexterity decline due to weak and swollen joints, potentially causing a limp.

Increased joint stiffness: As inflammation worsens (especially in the morning), the duration of joint stiffness lengthens.

Affecting larger joints: Beyond fingers and toes, patients may experience progressive symptoms in joints such as the knees, ankles, wrists, elbows, hips, and shoulders.

Red skin: The inflamed joint area reddens due to dilated capillaries under the skin caused by inflammation.

Complications when the disease worsens or is left untreated include:

Rheumatoid nodules: These are lumps appearing on the skin in some patients, often on the elbows, fingers, or heels. They form suddenly but grow slowly, indicating worsening disease progression.

Vasculitis: Rheumatoid arthritis can lead to a condition called rheumatoid vasculitis, causing skin ulcers. If vasculitis affects large arteries, it can result in nerve damage, impacting hands and feet, or damage internal organs.

Eye inflammation: Inflammation can affect various parts of the eye, including the episclera (a thin membrane covering the white of the eye) and the sclera (the white of the eye). Eyes may become red and painful, potentially leading to vision loss in severe cases.

Lung disease: Patients with rheumatoid arthritis have a higher risk of lung inflammation and scarring. The disease can also cause lung nodules, pleurisy (inflammation of the lung lining), and small airway obstruction due to chronic inflammation in the lung walls.

Carpal tunnel syndrome: If rheumatoid arthritis affects the wrist, inflammation can compress the nerve that controls the hand and fingers, known as the median nerve, leading to carpal tunnel syndrome.

Heart problems: Inflammation affects the heart and blood vessels, increasing the risk of heart disease.

Anemia: Chronic inflammation can reduce red blood cell production in the bone marrow, leading to anemia. Anemia caused by rheumatoid arthritis often resolves as inflammation decreases.

Joint symptoms from rheumatoid arthritis typically develop gradually over several years, but some people experience rapid and severe progression. A few only have temporary disease, followed by remission. When early signs appear, patients should seek timely diagnosis and treatment. Rheumatoid arthritis cannot be cured, but symptoms can be managed, progression slowed, and the risk of complications reduced.

Anh Ngoc (According to Verywell Health)