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If you have rheumatoid arthritis, the first thing you may notice is a dull ache, stiffness, and swelling in two matching joints — for example, both elbows, both knees, or both index fingers. The most typical sites for RA are the fingers and wrists, but it can also settle in the hands, elbows, shoulders, neck, hips, knees, ankles, and feet. See Figure 3-3.

Although pain and inflammation are early signs of RA, they’re not always the first to herald the arrival of the disease. RA typically begins with minor symptoms and slowly makes its presence known. But it can also strike dramatically, causing several joints to become inflamed all at once.

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FIGURE 3-3: The areas where rheumatoid arthritis is most likely to strike.

Although the symptoms of rheumatoid arthritis vary, most people with RA experience one or more of the following:

 Pain, warmth, redness, swelling, or tightness in a joint

 Swelling of three or more joints for six or more weeks

 Joints affected in a symmetrical, mirror-image pattern (for example, both knees, both shoulders, and so on)

 Joint pain or stiffness lasting longer than 30 minutes upon arising or after prolonged inactivity

 Pea-shaped bumps under the skin (called rheumatoid nodules), especially on pressure points like the elbows or the feet, or overlying affected joints. In bedridden patients, they may also occur at the base of the scalp or on the back side of the hip

 Evidence of joint erosion on an X-ray

 Loss of mobility

 General soreness, aching, stiffness

 A general “sick” feeling (malaise)

 Fatigue

 Periodic low-grade fever and/or sweats

 Difficulty sleeping

 Anemia caused by chronic inflammation in the body

 Blood tests showing the presence of positive rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) antibody. These are antibodies that are found in up to 80 percent of RA patients.

As RA progresses, the joints enlarge and can become deformed. They may even freeze in a semicontracted position, making complete extension impossible. The fingers can start to curl up, pointing away from the thumb, as their tendons slip out of place. RA may also attack other parts of the body, causing the following conditions:

 Pleurisy: If RA attacks the lungs, it can cause pleurisy (inflammation of the membranes around the lungs), prompting difficulty in breathing, chest pain, and scarring and inflammation of the lungs causing chronic dry cough and difficult breathing, especially with exercise.

 Episcleritis or scleritis: If it attacks the tissues covering the white part of the eye, it can cause eye pain, sensitivity to light, and tearing of the eye.

 Pericarditis: If it settles in the membrane surrounding the heart (a condition called pericarditis), it can cause chest pain while lying down, or impair the heart’s ability to pump blood properly.

 Vasculitis: If it affects the blood vessels (vasculitis), the blood supply to other parts of the body can be cut off, causing nerve damage, skin ulcers, gangrene, and other types of tissue death.

Even though rheumatoid arthritis can have some very serious consequences, this disease can be managed. Many people with RA live long, successful lives, and we now have many FDA-approved medications that can improve quality of life, level of function, and protect the joints from permanent damage and deformity. But remember: Early treatment can make a big difference in RA, so don’t wait to see a doctor.The earlier RA is diagnosed and treated, the better the overall prognosis and the higher the likelihood that the disease can be controlled.