Symptoms of rheumatoid arthritis can be divided into three main categories: joint symptoms, systemic symptoms (those affecting the whole body) and symptoms affecting other organs.

Joint symptoms

The most common symptom of rheumatoid arthritis is painful, stiff, swollen joints. It usually develops gradually in joints on both sides of the body, often affecting the small joints of the hands or feet first. Other joints that may be affected are:

• neck
• wrists
• elbows
• shoulders
• ankles
• knees

The pain of rheumatoid arthritis is described as deep and aching. It is usually at its worst after periods of rest (e.g. first thing in the morning) and may improve by gently moving the joint. The pain often occurs at night, disrupting sleep.

Affected joints feel stiff, particularly in the morning. The stiffness can last for several hours after getting up. This is characteristic of rheumatoid arthritis and helps distinguish it from osteoarthritis.

The inflammation of rheumatoid arthritis causes the affected joints to become swollen, red and hot. As the disease progresses, cartilage and bone are destroyed, limiting the movement of the joint and leading to deformities.

Systemic symptoms

Systemic symptoms are those that affect the whole body. In rheumatoid arthritis, systemic symptoms are due to the effects of high concentrations of inflammatory chemicals in the body. Symptoms include:

• tiredness
• loss of appetite
• weight loss
• anaemia (low red blood cell count; this can cause tiredness, dizziness, breathlessness and palpitations)
• fever and flu-like symptoms

Symptoms affecting other organs

Rheumatoid arthritis can affect systems in the body apart from the joints.

Skin
In the skin, small lumps may develop, particularly on the outside surfaces of joints. These are called rheumatoid nodules and are caused by the inflammatory process. They occur in around 20% of cases of rheumatoid arthritis.

Eyes
In about 15% of cases, rheumatoid arthritis is part of a condition called Sjögren’s syndrome. This is the name used to describe the combination of dry eyes, dry mouth and rheumatoid arthritis. It occurs when the tear and salivary glands become infiltrated by inflammatory cells. Scleritis (painful, red eye) can also occur.

Lungs
The inflammatory process of rheumatoid arthritis can affect the lungs in a number of ways. The most common are pleural effusion (water on the lung), pulmonary fibrosis (the development of scar tissue in the lungs) and rheumatoid nodules in the lungs.
Heart and blood vessels

People with rheumatoid arthritis have a higher than usual risk of developing cardiovascular diseases such as atherosclerosis (hardening of the arteries), heart attack or stroke.

Kidneys
Rheumatoid arthritis can cause an abnormal protein called amyloid to build up in the kidneys, affecting their normal function.

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