Rheumatoid arthritis may begin subtly, affecting only a few joints, or it may begin with a sudden flare-up involving many joints. Often, the first sign of rheumatoid arthritis is non-specific symptoms such as fatigue, a low-grade fever, and loss of appetite and weight. Weakness and a general malaise may continue throughout the course of the illness, often being most pronounced in the early afternoon.
Rheumatoid arthritis varies in intensity from person to person. It can range from mild, chronic discomfort to severe pain with limited motion and deformity. Rheumatoid arthritis usually attacks the hands and feet, causing inflammation that results in swelling, pain, and often, eventual destruction of the tissue that lines and cushions joints. The cause of this inflammation is unknown, but we do know it attacks in a symmetrical pattern – that is, it affects the same joint on both sides of the body.
Pain and Stiffness
The classic symptom of rheumatoid arthritis is morning joint pain and stiffness that eases as the day progresses – the so-called rusty gate syndrome. Pain and stiffness also occur after intense activity. These periods of pain and stiffness will generally lengthen as the disease becomes more active.
Typically, small joints in the fingers, toes, hands, feet, wrists, elbows, and ankles become inflamed first. They may become red, warm, and swollen, and the skin over the joint may take on a ruddy, purplish hue. Infected joints usually enlarge and can quickly become deformed. They may also “freeze” in one position, temporarily or permanently.
Rheumatoid Nodules
Another characteristic of rheumatoid arthritis is formation of rheumatoid nodules, small lumps of tissue that form under the skin, usually near the joints. These nodules are found in 30 to 40% of patients.
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