Especially in the early stages, Rheumatoid arthritis, also known as inflammatory arthritis, may be mistaken for osteoarthritis, a degenerative joint disease. However, inflammatory arthritis has distinct symptoms that you should not ignore.
Subtle and Generalized Symptoms
Inflammatory arthritis symptoms start subtly over weeks to months, and they may appear to be harmless. While you could feel unwell, you may not be able to pinpoint exactly what’s wrong.
Weight loss, anorexia, fatigue, inability to sleep, generalized weakness and diffuse joint pain are common. These symptoms may wax and wane over the day or several days. Unlike osteoarthritis, inflammatory arthritis affects the whole body because it’s an autoimmune disease. The immune system attacks the body that it’s supposed to protect.
The hallmark of inflammatory arthritis is the influx of white blood cells, pro-inflammatory proteins and autoantibodies. Your immune system’s high activity level is primarily responsible for your symptoms.
In some 5 to 15% of cases, the onset of symptoms is acute and explosive, often developing over 24 to 48 hours. In an acute onset, you may experience pain and swelling in multiple joints.
Swelling and tenderness of the lymph nodes are also common. However, there is no exact pattern to it. You may have it in your knee, groin, armpit or neck. Your spleen may become enlarged, and you may develop a low-grade fever of about 98.6 to 100.4 degrees Fahrenheit. A high-grade fever suggests an infection.1
Painful, Boggy Joints
A predominant feature of inflammatory arthritis is the symmetry of joint pain and swelling. This means that if you have symptoms on your left wrist, you will also have symptoms on the right. The first and second joints of the fingers, the elbows, shoulders, hips, ankles and knees are commonly affected. However, in some cases only a few joints may be affected, and symmetry may not be apparent especially in the early stages.
Researchers say that bone erosion starts one to two years after the onset of symptoms and increases by 1 to 3% per year.2
Attacked by the immune system, the thin tissue that covers the joint becomes inflamed and thickened. You will notice that your joints are red, painful, tender, warm, swollen and soft or mushy to touch (sometimes referred to as “boggy”). In contrast, an osteoarthritic joint is hard, bony and is asymmetrically distributed. Your joints may freeze so they are unable to bend or open; your fingers may turn slightly outward in the advanced stages of the disease.
If inflammation persists or goes untreated, it damages the cartilage and tendons. The bone also begins to erode. Bone erosion is an unmistakable sign of inflammatory arthritis. Researchers say that bone erosion starts one to two years after the onset of symptoms and increases by 1 to 3% per year.2
In inflammatory arthritis, the symptoms usually last more than six weeks. If you have symptoms that resolve in less than six weeks, you may have an acute viral infection or a gout attack, which usually involves the big toe. If you have psoriasis and knee pain with no signs of inflammation, you may have osteoarthritis; if it is inflamed, you may have psoriatic arthritis.
Another characteristic of inflammatory arthritis is stiffness that persists more than an hour and often lasts several hours. In osteoarthritis, stiffness lasts less than 30 minutes. The stiffness is especially predominant in the mornings, but also occurs after long periods of inactivity throughout the day.
Occasional Additional Inflammatory Arthritis Symptoms
Up to 40% of cases of inflammatory arthritis develop symptoms outside of the joints, medically referred to as extra-articular features. Extra-articular features suggest that you have high levels of autoantibodies, such as the rheumatoid factor in rheumatoid arthritis. Autoantibodies work with other inflammatory proteins to destroy the joint. Needless to say, having high levels of autoantibodies indicates that your condition is poorly controlled. Ultimately, the presence of extra-articular features with high levels of autoantibodies is associated with poor prognosis.3
The most common extra-articular feature is the formation of nodules on the elbows, arms and also the pressure points of the feet, ankles and sacrum (the triangular-shaped bone at the bottom of the spine). They rarely appear on visceral organs like the heart, lungs or the eye.
Other extra-articular symptoms include:
- Pericarditis: sharp chest pain, disabling chest pressure
- Vasculitis: rashes, dark spots on the skin
- Sjogren’s Syndrome: dry eyes, tearing, light sensitivity
- Interstitial lung disease: shortness of breath, persistent coughing
If you have any of the above extra-articular symptoms, you need to consult with your physician immediately.
In summary, if you experience the following symptoms, it’s time to schedule an appointment with your primary care provider:
- Symmetrical joint pain
- Swelling and tenderness in three or more joint areas for at least six weeks
- Stiffness that lasts more than an hour
- Subtle and general symptoms such as anorexia, fever, fatigue
Also, understand that these symptoms alone are not enough to diagnose inflammatory arthritis. Bone changes (seen on x-ray or MRI) and the presence of auto-antibodies will need to be tested. The earlier you get diagnosed, the more likely you can improve your quality of life.
1 Firestein GS. Etiology and pathogenesis of rheumatoid arthritis. In: Ruddy S, Harris E, Sledge C (eds): Kelly’s Textbook of Rheumatology. 6th ed. Philadelphia: WB Saunders, 2001, 921-966.
2 Scott D, Kingsley G, Scott D. Inflammatory Arthritis in Clinical Practice. London: Springer; 2008.
3 Gonzalez-Lopez L, Gamez-Nava JI, Jhangri G, et al. Decreased progression to rheumatoid arthritis or other connective tissue diseases in patients with palindromic rheumatism treated with antimalarials. J Rheumatol 2000; 27:41.