joint pain and swelling

The most common symptom of rheumatoid arthritis is pain and swelling in the affected joints. These symptoms occur in almost all patients and are characteristic of the disease.

The inflammation in the joints causes tissue thickening and the production of excess synovial fluid. This causes swelling and pain.

The small joints of the hands and feet are most commonly affected. But larger joints such as knees, hips or shoulders can also be affected. The pain is usually symmetrical, meaning it affects both halves of the body equally.

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Joint stiffness & morning stiffness

Another common symptom is the stiffness of affected joints. Stiff joints occur particularly after periods of rest, such as after sleeping in the morning. This is why it is also referred to as morning stiffness.

Joint stiffness in rheumatoid arthritis can last from a few minutes to several hours. It is caused by an accumulation of inflammatory cells and fluid in the joints.

With advanced disease or in acute attacks, this stiffness can last longer and significantly affect the daily lives of those affected.

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Exhaustion (fatigue)

Another common accompanying symptom is chronic exhaustion, also known as fatigue. In rheumatoid arthritis, fatigue is probably due to the increased physical strain caused by systemic inflammation. Systemic inflammation not only affects a localised area, but the whole body.

Certain messenger substances, the so-called pro-inflammatory cytokines, play a role in the immune response. They presumably promote this form of fatigue in rheumatoid arthritis by influencing the central nervous system.

Cytokines that have gained attention in the scientific community are tumour necrosis factor-α (TNF-α) and interleukin-6 (IL-6). These cytokines are inhibited in the treatment of rheumatoid arthritis with biologics, among other things, in order to alleviate the immune response and associated symptoms.

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Loss of joint function and deformities

As RA progresses, permanent joint damage can occur, resulting in loss of joint function. This occurs when the inflammation in the joint becomes chronic and the cartilage and bone are destroyed.

In severe cases, joint deformities can occur, which are characterised by a misalignment of the joints. Well-known deformities are swan neck deformity and buttonhole deformity, which mainly affect the fingers.

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Rheumatoid nodules

Subcutaneous nodules develop in around 20-30% of patients. These lumps under the skin are known as rheumatoid nodules. They typically occur at pressure points such as the elbows, forearms or hands.

Rheumatoid nodules consist of inflammatory tissue and are a sign of a more severe form of the disease. They are caused by chronic inflammation and the resulting tissue reaction.

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Fever and weight loss

In less frequent cases, there may be a slight fever and unintentional weight loss. These symptoms are an expression of the systemic inflammatory reactions in the body and often occur in conjunction with acute flare-ups of the disease.

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Depression and anxiety

Psychological side effects such as depression and anxiety are not uncommon in RA patients. The chronic nature of the disease, the persistent pain and the physical limitations contribute to a higher prevalence of mental disorders in people with RA. In addition, the inflammatory processes can also directly affect the central nervous system and lead to neuropsychiatric symptoms.

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Systemic concomitant diseases

The most common symptoms of rheumatoid arthritis occur in or around the joints. However, studies show that rheumatoid arthritis can increase the risk of secondary diseases. This is also referred to as comorbidity.

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Cardiovascular diseases

Rheumatoid arthritis is associated with a greatly increased risk of cardiovascular disease. According to studies, the risk is twice as high as in people who do not suffer from RA [11,12].

This is because chronic inflammation promotes the formation of plaques in the arteries [12]. In medical terms, these deposits are known as atherosclerosis. This increases the risk of heart attacks and strokes. Inflammation can also affect the heart muscle or pericardial tissue, which can lead to pericarditis.

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Lung problems

Many RA patients develop lung problems during the course of the disease [13]. These are often due to damage to the connective tissue of the lungs [14]. This is referred to as interstitial lung disease, or ILD for short.

ILDs comprise more than 200 diseases. Initial symptoms are often non-specific. They include coughing or breathlessness on exertion. If such symptoms occur, they should be discussed with the treating physicians in order to speed up the diagnosis and initiation of treatment.

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Eye diseases

In 8-30% of cases, rheumatoid arthritis can also affect eye health. If inflammatory reactions occur in the eye area, this can lead to dryness of the eyes and inflammation. According to studies, the wetting of the eye surface is more frequently disturbed in RA patients.

The risk of developing Sjögren's or sicca syndrome is also increased in patients with rheumatoid arthritis [15,16].

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Diseases of the skin and bones

Secondary diseases of the skin and bones can also occur.

According to studies, rheumatoid arthritis manifests itself in the skin in 15-25% of patients during the course of the disease [17]. These manifestations can include rheumatoid nodules or rheumatoid nodules, vasculitis and Sweet's syndrome (neutrophilic dermatosis).

Less frequently, vascular changes, ulcers on the legs or Raynaud's syndrome may occur. Psoriasis also occurs more frequently in RA patients than in non-RA patients.

In 30-80% of cases, rheumatoid arthritis also manifests itself in bone health [18-20].

Long-term inflammation and the use of glucocorticoids to treat RA can lead to a decrease in bone density and an increased susceptibility to osteoporosis. Osteoporosis is a disease characterised by a decrease in bone density and increased bone fragility. This is a common complication in RA patients and increases the risk of bone fractures.