Symptoms

Rheumatoid arthritis (RA) may be difficult to diagnose because of its subtle and wide-ranging symptoms. In almost all people who have RA, joint inflammation comes and goes, but RA generally persists over a lifetime. The disease may be mild in some people, with only periods of flares (episodes of worsening joint inflammation). In others, the disease may be very active and may worsen, or progress, over time. Approximately 1 in 10 people with RA has a single flare, followed by a long-lasting remission when no symptoms are present.

Symptoms that may indicate RA include the following:

• Swelling
• Sensation of heat in the joints
• Limited ability to move certain joints
• Appearance of nodules or lumps under the skin

Joint inflammation often occurs in many small and large joints of the hands and feet. In addition, people with RA often complain about overall fatigue and sickness as well as a feeling of persistent joint stiffness in the morning.

Diagnosis

Researchers believe joint destruction may begin within the first year of disease onset. Therefore, early diagnosis and disease modification therapy is important. To diagnose RA, your physician may inquire about your medical history and perform a physical examination. He or she may look for certain RA symptoms, including swelling, warmth, limited motion in joints throughout your body, and nodules or lumps under the skin. Your doctor also may ask if you have been experiencing fatigue and overall stiffness, especially when you first get up.

Rheumatologists often are involved in diagnosing or confirming an RA diagnosis and developing a disease modification plan. The American College of Rheumatology's diagnostic criteria for RA include the following:

• Presence of arthritis for longer than 6 weeks
• Prolonged morning stiffness in the joints
• Presence of characteristic nodules under the skin
• Joint erosions apparent on X-ray
• Positive blood test for an antibody known as rheumatoid factor (It is important to note, however, that approximately 25 percent of people with RA never develop this antibody, and people who do not have RA also may develop the antibody.)