Here’s what sets RA apart from other causes of joint stiffness.
Everyone expects to deal with joint pain at some point. Maybe your wrist is throbbing after you played tennis out of the blue after a decade of your racquet gathering dust in the garage. Or your knees are totally killing you after a full day of sightseeing on vacation.
But if your joint pain feels like more than simply losing some of your youthful agility and nimbleness, there might be another cause. One possibility has little to do with how hard you stressed your body yesterday. Rheumatoid arthritis, or RA, is an autoimmune disease that causes the immune system to turn against the body’s joints. The inflammation caused by this attack leads to a unique type of joint stiffness and swelling.
Joint pain can occur for a number of reasons, but these signs may indicate your pain is actually caused by RA, according to Ashira Blazer, MD, a rheumatologist at NYU Langone Medical Center.
1. Your joints are stiff for hours in the morning.
For rheumatoid arthritis patients, inflammation of the joints tend to be worst during periods of rest, so joint pain from RA is understandably present after eight hours in bed. Similarly, joint pain may flare up after long periods of sitting, like while watching a movie at the cinema (or several episodes of Friends on your couch).
“Generally, other causes of arthritis—such as osteoarthritis—can cause some stiffness, but no longer than 30 minutes,” says Dr. Blazer. “When a patient says that they’re stiff for an hour, or two hours, [or] maybe all morning long, I start to think about rheumatoid arthritis because that suggests inflammation.”
2. Your small joints ache.
RA typically affects little joints, like your knuckles, wrists, and elbows. Because RA is caused by inflammation, not wear and tear, the arthritis pain does not necessarily show up as often in weight-bearing joints like the knees.
3. Your joint pain is symmetrical.
Symmetrical joint swelling is a classic symptom of rheumatoid arthritis. “If it affects one or two joints on one side of the body, it tends to affect the same joints on the other side of the body,” says Dr. Blazer.
That said, early RA may affect only a couple joints at random, and symmetry may not occur until the condition has further set in, according to Johns Hopkins Arthritis Center.
4. Multiple joints are affected.
Pain located in a single joint could be caused by another condition (say, carpal tunnel). But if RA is present and causing inflammation, you’ll likely feel pain in multiple joints.
A 2011 study in American Family Physician Journal concluded that the more joints that were affected, the higher the likelihood of an RA diagnosis. “We would almost rule out someone who has maybe one or two joints affected,” says Dr. Blazer. “We’re really looking for multiple joints, symmetric, on both sides of the body.”
5. Hot showers provide relief of joint pain.
Heat from hot showers (as well as heating pads, whirlpools, and electric blankets) can all ease pain caused by RA, according to the Arthritis Foundation. If these warming techniques work for you, you may have RA. The heat helps loosen the synovial fluid surrounding the joint, which provides lubrication and helps relieve stiffness.
6. Using your joints help improve your symptoms.
Staying active is a main component of RA treatment. While pain and stiffness may prompt you to use your joints less, you may find that using them actually soothes the pain. This may be a sign your joint pain is due to RA, as opposed to an injury or another type of arthritis.
A 2018 study from Arthritis Research & Therapy found that participants with RA had more sensitivity to pressure pain than control subjects without RA during periods of rest. However, during and after muscle contractions, participants with RA noticed a significant reduction in pain.
Learn more about why physical activity can help arthritis symptoms.
7. You feel generally unwell.
If your joint pain is also accompanied by fatigue, low fevers, and loss of appetite, that may signal you have RA, according to the American College of Rheumatology. Flu-like symptoms occur when the immune system is activated. RA inflammation can also affect other organs in the body, which could result in other symptoms such as dry eyes and mouth.
Being diagnosed with rheumatoid arthritis may be a life-changing event, but it doesn’t have to limit you. Check out fashion designer Michael Kuluva’s tips for living well with RA.
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(subtle dramatic music)
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and are you stiff in the morning?
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(subtle dramatic music)
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Generally, other causes of arthritis, such as
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osteoarthritis, can cause some stiffness, but no longer
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than 30 minutes.
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But when a patient says that they're stiff for an hour,
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or two hours, maybe all morning long, I start to think
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about rheumatoid arthritis because
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that suggests inflammation.
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Rheumatoid arthritis is an autoimmune disease,
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which means that the immune system, which is supposed to be
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your protection against viruses or bacteria, becomes
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active against your own tissues.
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And in rheumatoid arthritis these are the joint tissues.
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And it affects joints that aren't necessarily the ones
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that you use more often.
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So, even knuckles or the elbows, joints that are
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not necessarily weight bearing can be involved
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in rheumatoid arthritis.
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In RA joint pain tends to be symmetrical.
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So if it affects one or two joints on one side of the body
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it tends to affect the same joints on the other
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side of the body.
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We would almost rule out someone who has maybe one
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or two joints affected.
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So we're really looking for multiple joints,
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symmetric on both sides of the body.
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And usually patients who have rheumatoid arthritis
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will say, if I wake up in the morning and I'm stiff,
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I take a hot shower, and the warm water from the shower
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will help to loosen my joints and make them feel better.
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Or, they'll tell me that they are using their joints more,
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and the more I use my joints, the better I feel.
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So those are signs that this might be rheumatoid arthritis,
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rather than other sorts of joint pain.
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Along with the joint pain caused by RA, patients
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tend to have systemic symptoms.
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And again, this is because the immune system is active.
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So, it's similar to when you've got a cold or a flu,
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if the immune system is active, you've got
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some fatigue, maybe low grade fevers, you sort of feel
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like you're ill.
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The first thing that a person who suspects they have
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rheumatoid arthritis should do is contact
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their primary care physician.
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So the primary care physician can help to do
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an initial workup and then refer to a specialist
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who would be able to diagnose it definitively,
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and start therapies.
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It's imperative to get treatment as early as possible,
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because the inflammation doesn't just cause pain,
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it also causes damage to the joint structures
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and to the bone.
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You know, before we had state of the art therapies,
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patients would end up with deformities and be unable
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to use their joints at all.
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And we can protect against that if we control
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the inflammation to the best of our ability.
Lofgren M, Opava CH, Demmelmaier I, Friden C, Lundberg IE, Nordgren B, Kosek E. Pain sensitivity at rest and during muscle contraction in persons with rheumatoid arthritis: a substudy within the Physical Activity in Rheumatoid Arthritis 2010 study. Arthritis Res Ther. 2018 Mar 15;20(1):48.
Rheumatoid arthritis. Atlanta, GA: American College of Rheumatology. (Accessed on March 23, 2018 at https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Rheumatoid-Arthritis.)
Rheumatoid arthritis self-care. Atlanta, GA: Arthritis Foundation. (Accessed on March 23, 2018 at https://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/self-care.php.)
Rheumatoid arthritis signs and symptoms. Baltimore, MD: Johns Hopkins Arthritis Center. (Accessed on March 23, 2018 at https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-symptoms/.)
Warming techniques to relieve rheumatoid arthritis pain. Atlanta, GA: Arthritis Foundation. (Accessed on March 23, 2018 at https://www.arthritis.org/living-with-arthritis/pain-management/tips/warming-techniques-rheumatoid-arthritis-pain.php.)
Wasserman AM, Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2011 Dec 1;84(11):1245-52.