Rheumatoid Arthritis: What Are the Early Symptoms?

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory condition. It develops when the immune system mistakenly attacks the lining of the joints, causing inflammation, pain, stiffness, and swelling.

RA can affect more than the joints, and everyone's experience is different. Symptoms may develop gradually over several weeks or, for some people, appear more quickly.

You can find more information about the condition, its symptoms and treatments in Carenity's Rheumatoid Arthritis Fact Sheet.

What are the early symptoms of rheumatoid arthritis?

The early signs of rheumatoid arthritis are not exactly the same for everyone. However, joint pain, stiffness, and swelling are particularly common.

Early RA symptoms may include:

• Joint pain or tenderness, particularly in the hands, fingers, wrists and feet,
• Joint swelling, which may make a joint appear or feel puffy,
• Morning stiffness that lasts longer than you might expect,
• Stiffness after periods of inactivity,
• Warmth around affected joints,
• Difficulty moving or using affected joints normally,
• Fatigue or unusual tiredness,
• A general feeling of being unwell.

For some people, fatigue or a general sense that something is not quite right may appear alongside or sometimes before, more obvious joint symptoms.

What does rheumatoid arthritis morning stiffness feel like?

Morning stiffness is one of the characteristic symptoms of inflammatory arthritis.

Someone with early rheumatoid arthritis may wake up feeling as though their fingers, hands or other affected joints are difficult to move. Stiffness can make everyday tasks such as making a fist, opening a jar, getting dressed or holding objects more difficult.

Unlike the brief stiffness often associated with osteoarthritis, inflammatory morning stiffness can last considerably longer and may gradually improve as you begin moving.

However, the duration of morning stiffness alone cannot diagnose rheumatoid arthritis.

If you're wondering about the differences between the two conditions, read Carenity's article Rheumatoid arthritis and osteoarthritis: How are they similar and different?

Where does rheumatoid arthritis usually start?

Early rheumatoid arthritis often affects the small joints of the hands and feet, including the knuckles, finger joints, wrists and joints near the base of the toes.

More than one joint may be affected.

RA is often described as symmetrical, meaning similar joints on both sides of the body can be involved - for example, both wrists or both hands.

However, this is an important point: early rheumatoid arthritis is not always symmetrical from the beginning. Having symptoms on only one side does not automatically rule out RA.

As the condition develops, other joints such as the ankles, knees, elbows, and shoulders may also become involved.

Is fatigue an early sign of rheumatoid arthritis?

Yes, rheumatoid arthritis fatigue can be an early symptom.

Some people describe feeling unusually tired, lacking energy, or generally unwell. This can sometimes appear alongside joint symptoms and may have a significant effect on everyday activities.

Fatigue has many possible causes, however, feeling tired does not necessarily mean you have rheumatoid arthritis.

It becomes more useful to tell your GP about fatigue when you can explain the bigger picture. For example, whether it began around the same time as persistent joint pain, swelling or morning stiffness.

Rheumatoid arthritis or everyday joint pain: when should you pay attention?

An occasional painful or stiff joint does not necessarily mean rheumatoid arthritis. Joint symptoms can have many causes, from injury and overuse to other forms of arthritis.

What matters is the pattern and persistence of the symptoms.

Consider speaking to your GP if you notice:

• Persistent joint pain, swelling or stiffness,
• Swelling in the small joints of your hands or feet,
• More than one affected joint,
• Morning stiffness that keeps returning,
• Symptoms that are becoming more frequent or severe,
• Joint symptoms that are beginning to interfere with everyday activities.

You do not need to work out whether it is rheumatoid arthritis yourself. A healthcare professional can assess your symptoms and decide whether further investigation or referral is needed.

How is early rheumatoid arthritis diagnosed?

There is no single test that can diagnose rheumatoid arthritis on its own.

Your GP will usually ask about your symptoms and examine your joints for signs such as swelling, tenderness, and reduced movement.

Blood tests may be used to look for inflammation and antibodies associated with rheumatoid arthritis. These can include:

• Rheumatoid factor (RF),
• Anti-cyclic citrullinated peptide (anti-CCP) antibodies,
• C-reactive protein (CRP),
• Erythrocyte sedimentation rate (ESR).

Imaging such as X-rays may also form part of the assessment, while ultrasound or MRI can sometimes provide additional information.

Importantly, normal inflammatory markers or negative rheumatoid factor or anti-CCP tests do not automatically rule out rheumatoid arthritis. If persistent joint inflammation is suspected, further assessment may still be necessary.

Why does early diagnosis of rheumatoid arthritis matter?

Recognizing rheumatoid arthritis early matters because persistent inflammation can eventually damage joints.

Modern rheumatoid arthritis treatment aims to control inflammation, relieve symptoms, and reduce the risk of joint damage. Starting appropriate treatment early is therefore an important part of managing the condition.

If you'd like to understand what can happen after diagnosis, Carenity's article How does rheumatoid arthritis progress and how is it treated?explains RA progression, diagnosis and treatment in more detail.

What should you tell your GP about your symptoms?

When joint symptoms come and go, remembering exactly when everything started can be difficult.

Before your appointment, consider noting:

• Which joints hurt or feel stiff,
• Whether you have noticed visible swelling,
• Whether one or both sides of your body are affected,
• When symptoms are worst,
• Approximately how long morning stiffness lasts,
• How long you have had the symptoms,
• Whether symptoms come and go or are persistent,
• Any fatigue or other changes you have noticed,
• How the symptoms affect everyday tasks.

You could also take photographs if swelling is clearly visible at certain times but tends to disappear before appointments.

These notes are not about diagnosing yourself. They can simply give your GP a clearer picture of the pattern of your rheumatoid arthritis symptoms and help them decide what should happen next.

Finding support while looking for answers

Waiting for answers about unexplained joint pain, morning stiffness, swelling or fatigue can be frustrating, particularly when symptoms come and go or are difficult to explain.

While you are going through the diagnosis process, connecting with a rheumatoid arthritis community can give you an opportunity to hear how other people recognized their early symptoms, what questions they asked and what their journey towards diagnosis was like.

In the Carenity rheumatoid arthritis community, members discuss their experiences of diagnosis, symptoms and living with RA. You can also join the discussion Rheumatoid arthritis diagnosis: What kind of tests did you undergo? to read about members' experiences and exchange with others.

If you prefer, simply reading conversations in an RA support community may help you find words to describe what you are experiencing or think of questions to bring to your next appointment.

Remember that every person's experience of rheumatoid arthritis is different. Community support can offer reassurance and shared experience, but it should complement, not replace any assessment and advice from your GP or rheumatology team.

Key takeaways

The first signs of rheumatoid arthritis can be easy to overlook. Persistent morning stiffness, swollen or tender joints, pain in the hands, wrists or feet and unexplained fatigue are all symptoms worth paying attention to.

Having these symptoms does not necessarily mean you have RA, and you do not need to diagnose yourself.

If joint pain, stiffness, or swelling persists or begins affecting everyday life, speak to your GP. Recognizing inflammatory arthritis early can help you get the right assessment and, if needed, appropriate treatment sooner.

Frequently Asked Questions

1. What are the first signs of rheumatoid arthritis?

Early rheumatoid arthritis symptoms commonly include joint pain, swelling, tenderness and morning stiffness, particularly in the hands, wrists, and feet. Fatigue may also occur.

2. How long does morning stiffness last with rheumatoid arthritis?

Inflammatory morning stiffness can last longer than the brief stiffness often associated with osteoarthritis. However, duration alone cannot confirm rheumatoid arthritis.

3. Does rheumatoid arthritis always start in both hands?

No. RA often becomes symmetrical, but early rheumatoid arthritis does not always affect both sides of the body at the same time.

4. Can you have rheumatoid arthritis with a negative blood test?

Yes. Negative rheumatoid factor, anti-CCP antibodies or normal inflammatory markers do not by themselves exclude rheumatoid arthritis. Diagnosis considers symptoms, examination, and other investigations.

5. When should I see a GP about possible rheumatoid arthritis symptoms?

Speak to your GP if you have persistent joint pain, stiffness or swelling, particularly when small joints of the hands or feet or multiple joints are affected.

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