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Rheumatoid arthritis (RA) is a highly individualized condition that acts differently in each patient. Typically, the signs and symptoms begin slowly over a period of weeks to several months. However, in about 10 to 15 percent of patients, the disease may start suddenly with the inflammation and swelling of several joints developing very quickly. It is important that patients seek professional care immediately when this happens to rule out the possibility that other causes may be at work.

Rheumatoid arthritis is a chronic disease, but it is not always actively causing symptoms. In fact, the symptoms often disappear, the tissue inflammation subsides and patients generally report feeling well. These periods of remission can occur spontaneously or be the result of treatment. They can last for weeks, months or even years.

When the disease becomes active again, the symptoms can return, sometimes with a vengeance. The return of disease activity and symptoms is called a flare.

Signs and Symptoms
The most common symptoms associated with rheumatoid arthritis are pain and swelling that usually occur in several joints at the same time. During the early stages of the disease, the wrists, hands, feet and knee joints are most often affected.

A telltale sign of rheumatoid arthritis is a symmetrical pattern of joint inflammation. That means joints on both sides of the body, such as the knuckles on both hands or the small joints in both feet, are affected simultaneously.

As the disease progresses, the joints in the shoulders, elbows, hips, jaw and neck may become involved. Eventually, the pain, swelling and resulting joint deformities lead to loss of motion because the joints don't move as well as they used to. It also causes a loss of strength in the muscles that are attached to the affected joints

In about 25 percent of patients, firm lumps called rheumatoid nodules will pop up beneath the skin at various pressure points. They can appear at the elbows, hands, feet and Achilles tendons, or they may show up at the back of the scalp, over a knee or in the lungs. These nodules, which occur in fewer than 10 percent of patients during the first year of disease, are usually not painful. They normally range in size from being as small as a pea to as large as a walnut.

A generalized feeling of aching or stiffness in the joints and muscles is also common. This usually occurs in the morning after sleep or following periods of rest. The morning stiffness may last anywhere from one to two hours or as long as the entire day. This is an important characteristic of active rheumatoid arthritis as most other arthritic diseases do not behave this way.

Effects of Rheumatoid Arthritis are Widespread
Many patients with rheumatoid arthritis report a general feeling of malaise, some have a low grade fever, and others say they experience a loss of appetite and weight loss. But the most debilitating symptom aside from joint pain is fatigue, which can be quite severe when the disease flares.

In surveys of patients with rheumatoid arthritis, fatigue is often mentioned as one of the most difficult aspects of the disease because it limits what the patient can do in terms of his or her everyday function.

Several factors may be responsible. Fatigue, accompanied by feelings of weakness and loss of energy, may be due to poor sleep quality or simply the result of not getting enough rest. It may also be linked to inflammation, a side effect of medication, or it could be caused by another condition such as depression. It is important to talk to a health professional to pinpoint the cause and receive appropriate treatment.

Because rheumatoid arthritis is a systemic disease, it can cause inflammation in widespread areas, even the tear glands and salivary glands. The result is dry eyes and mouth, symptoms which are typically associated with another related condition known as Sjogren's syndrome. Because of the decreased production of tears and saliva, patients with Sjogren's typically experience irritation, a gritty feeling or painful burning in the eyes. Dry mouth or difficulty eating dry foods and swelling of the glands around the face and neck are also common. Some patients experience dryness of other mucous membranes (such as the nasal passages, throat and vagina) and skin.

As the disease progresses, many other parts of the body also come under siege. Sometimes dark, purplish areas develop from bleeding under the skin because blood vessels are damaged by the widespread inflammation. That may also cause fluid to collect in and around the lungs. This can lead to severe complications if the tissues in the lungs become stiff. Breathing may become difficult as a result. Problems can also arise if the inflammation affects the heart muscle, the heart valves or the blood vessels of the heart.

Early Diagnosis is Key to Disease Management
Successful management of rheumatoid arthritis requires early diagnosis and aggressive treatment. By identifying the disease early and starting treatment as soon as possible, doctors can stop or reduce inflammation in the joints. This can prevent or reduce some of the painful symptoms. Treatment can also put a halt to or at least slow down the progressive joint destruction and deformity. Successfully managing the disease as early as possible will also help to prevent or lessen some of the disability and other complications that make rheumatoid arthritis so debilitating.