Joint pain and stiffness can happen for many reasons. But when symptoms keep coming back, especially in the same joints on both sides of the body, it may be a sign of rheumatoid arthritis (RA).
RA is a chronic autoimmune disease. This means the immune system mistakenly attacks healthy joints, causing inflammation, pain, and swelling. Early diagnosis and treatment can help manage symptoms, slow joint damage, and support long-term health.
To better understand RA, we asked Kristen Clark, physician assistant, about early signs and symptoms, how the disease can progress, how to test for RA, and more.
What are the first signs of rheumatoid arthritis?
“RA often starts gradually,” explains Clark. “Early symptoms may be mild at first and can become more noticeable over time.”
Some of the more common early signs and symptoms of RA include:
- Pain, swelling, or tenderness in small joints such as the fingers, wrists, or feet
- Symptoms affecting the same joints on both sides of the body, such as both hands or both wrists
- Morning stiffness that lasts 30 minutes or longer
- Soft, puffy swelling around affected joints
- Fatigue or low energy
- Mild fever or unintended weight loss in some people
One clue that may help distinguish RA from osteoarthritis (OA) is that RA usually does not affect the joints at the very tips of the fingers, though this is a joint commonly involved in OA. The most common form of arthritis, OA happens when the cartilage that cushions the ends of bones within a joint gradually breaks down, causing the bones to rub against each other. This can lead to pain, stiffness, swelling, and reduced joint function. It’s important to distinguish between RA and OA for appropriate treatment.
What does a rheumatoid arthritis flare feel like?
An RA flare is a period when symptoms become worse than usual. Flares can feel different from person to person, but many people experience:
- Increased joint pain, swelling, or tenderness
- More stiffness, especially in the morning
- Extreme tiredness or fatigue
- Difficulty with everyday tasks
- A need for extra rest
- Feeling generally unwell
“Living with a flare can also be emotionally challenging,” adds Clark. “Flares may last a few days, several weeks, or longer,” she says. “Some people may feel frustrated or discouraged when symptoms interfere with their daily routine.”
What are the stages of rheumatoid arthritis?
RA can develop over time, sometimes years before joint swelling becomes obvious.
Stage 1: Early rheumatoid arthritis
Inflammation and swelling in the joints may lead to mild symptoms in smaller joints (for example, stiffness in the fingers or feet).
Stage 2: Antibody formation and mild rheumatoid arthritis
The immune system begins producing RA-related antibodies. Symptoms may become more persistent and affect other joints throughout the body. Treatment during this stage can help slow the progression of RA.
Stage 3: Moderate rheumatoid arthritis
The disease becomes more severe, leading to cartilage damage and bone breakdown. Common symptoms include rheumatoid nodules, or firm lumps, under the skin and development of carpal tunnel syndrome.
Stage 4: Severe rheumatoid arthritis
Without effective treatment, ongoing inflammation may lead to decreased range of motion and difficulty using the hands or other affected parts of the body.
Not everyone with RA progresses through every stage of the disease. Early diagnosis and treatment can help reduce the risk of long-term joint damage.
How is rheumatoid arthritis diagnosed?
There is no single test that can diagnose RA. Instead, healthcare providers look at the complete picture, including symptoms, physical exam findings, blood test results, and imaging studies.
Common tests may include:
- Rheumatoid factor (RF): RF is an antibody, a type of protein made by the immune system that can mistakenly target the body’s own tissue. Small amounts of RF may be found in some healthy people. Higher RF levels, particularly when combined with inflammatory joint symptoms, may be associated with RA or other autoimmune conditions
- Anti-CCP antibodies: Anti-CCP is a blood test that is more specific for RA. A positive result can strongly support a diagnosis
- Inflammation tests (CRP and ESR): These blood tests measure inflammation in the body and can help providers understand how active the disease may be
- Imaging tests: X-rays can help identify joint damage. Ultrasound may also be used to look for signs of inflammation
When making a diagnosis, a rheumatologist considers which joints are affected, how long symptoms have been present, blood test results, inflammation levels, and whether another condition could be causing the symptoms.
What does it mean if my rheumatoid arthritis markers are high?
RA markers are blood tests that provide clues about what is happening in the immune system.
High levels of RF or anti-CCP antibodies can support a diagnosis of RA. People who test positive for these antibodies may have a higher risk of more severe disease and joint damage over time. These results can help guide monitoring and treatment decisions.
Providers also use C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) tests to measure inflammation. “Higher levels of CRP and ESR may indicate active inflammation,” explains Clark. “When these levels decrease over time, it can be a sign that inflammation is improving and treatment is helping, especially when accompanied by improvements in symptoms.”
It’s important to remember that blood test results are only one piece of the puzzle. A positive antibody test may indicate RA, but it does not confirm a diagnosis. Likewise, a negative antibody test may occur even in people who have RA. Symptoms, medical history, and a physical exam are all important parts of the diagnosis.
Who is at risk for rheumatoid arthritis?
Researchers don’t know exactly what causes RA, but several factors may increase the risk of developing the disease. These include:
- A family history of RA
- Smoking
- Obesity
- Certain environmental exposures
- Sex (RA is more common among women than men)
- Age (risk increases with age; symptoms usually start between ages 30-50, but can happen to people at any age)
Risk factors are just one part of the overall picture, notes Clark. Having one or more risk factors does not mean someone will develop RA; likewise, some people with RA have no known risk factors.
Can rheumatoid arthritis be cured?
There is currently no cure for RA. However, treatment can help manage symptoms, reduce inflammation, slow joint damage, and improve quality of life. Many people with RA can achieve periods of low disease activity or remission, meaning they experience few or no symptoms after a period of time.
“The earlier RA is diagnosed and treated, the better the chance of protecting joint health and maintaining daily function over time,” says Clark.
What to remember about rheumatoid arthritis: Key takeaways
RA is more than occasional joint pain. It is an autoimmune disease that can affect daily life and long-term joint health. Understanding the early signs, knowing what flares can feel like, and recognizing how RA is diagnosed can help people seek care sooner. Early treatment can make a meaningful difference in managing symptoms and protecting joint health over time.
