Signs and Symptoms of Arthritis
Arthritis symptoms can be vague and confusing, but they are important to recognize. Joint pain, stiffness, tenderness, and swelling could be due to an injury, but should be evaluated by a doctor if they persist to determine if arthritis is instead to blame. There are many types of arthritis, as well as variability in which joints are affected and how severely. While certain symptoms are common to most types of arthritis, differences are what distinguish one from another.
These symptoms occur in most types of arthritis and rheumatic diseases, and are the most frequent ones seen at onset:1
- Joint pain
- Joint stiffness
- Tenderness in and around the joint (joint counts)
- Joint swelling
- Limited range of motion in one or more affected joints
- Redness and warmth around the affected joints
- Lumps and bumps (nodules and nodes)
The symptoms will vary depending on the specific type of arthritis and rheumatic disease.
Rheumatoid arthritis (RA) is an autoimmune, inflammatory type of arthritis. While the joints are primarily affected by rheumatoid arthritis, there can be systemic effects as well.
Other symptoms and characteristics of RA include:
- Morning stiffness lasting more than an hour
- Involvement of the small bones of the hands and feet
- Extreme fatigue
- Rheumatoid nodules
- Symmetrical joint involvement (e.g., both knees are affected, not just one)
Osteoarthritis (OA) primarily affects the joints, and there are generally no systemic effects. The most common symptom associated with osteoarthritis is pain in the affected joint(s) after repeated use, which often worsens later in the day. The affected joints can swell, feel warm, and become stiff after prolonged inactivity.3
Osteoarthritis can occur with other forms of arthritis simultaneously. Bone spurs and bony enlargements are also characteristic of osteoarthritis.
Psoriatic arthritis is a type of arthritis associated with psoriasis (a skin condition characterized by red, patchy, raised, or scaly areas) and chronic joint symptoms. The symptoms of psoriasis and joint inflammation often develop separately.
Symptoms associated with psoriatic arthritis vary in how they occur (symmetrical or asymmetrical pattern) and which joints are affected; it can involve any joint in the body.4 When psoriasis causes pitting and thickened or discolored fingernails, the joints nearest the fingertips are likely to become arthritic.
Ankylosing spondylitis (AS) is commonly associated with inflammation that involves the spine and sacroiliac joints. The earliest symptoms are often chronic pain and stiffness in the lower back region and hips. Typical ankylosing spondylitis pain in the back worsens following rest or inactivity. As symptoms of pain and stiffness progress up the spine to the neck, possibly including the rib cage area, bones may fuse.
Lupus can affect the joints, nervous system, skin, kidneys, lungs, heart, and other organs of the body. Lupus can be difficult to diagnose, as it sometimes mimics other types of arthritis and rheumatic diseases.
A butterfly-shaped rash appearing on the cheeks and over the bridge of the nose (malar rash) is just one of the distinguishing characteristics of lupus.
Gout is considered one of the most intensely painful types of arthritis. It is characterized by sudden onset of severe pain, tenderness, warmth, redness, and swelling from inflammation of the affected joint.
Gout usually affects a single joint, often the big toe, though the knee, ankle, foot, hand, wrist, and elbow may be involved as well. The shoulders, hips, and spine may eventually be affected by gout, but rarely. Often, someone’s first gout attack occurs at night.
Besides the symptoms often seen in various rheumatic conditions, some present with less common ones.
Less commonly, AS may affect the heart, lung, or kidney. Heart failure and heart conduction defects may occur. Lung problems can develop due to limited chest wall and spine movement or from lung fibrosis. Kidney problems such as IgA nephropathy can also occur. Some of these problems may be life-threatening.
Five percent of cases of psoriatic arthritis are of the painful and destructive arthritis mutilans type. Enthesitis (inflammation where tendons and ligaments attach to bone) develops and there is resorption of phalangeal (finger) bones.
Lupus has a large assortment of common symptoms, making it a perplexing condition to diagnose, often involving ruling out other diseases. Less common symptoms of lupus include:
The complications of arthritis vary depending on the type of arthritis.
About 1 in 1000 children under age 16 have one of the forms of arthritis. The symptoms are similar to the adult symptoms seen for each type.
Bone loss is a concern as the inflammatory process and corticosteroid treatment can inhibit bone formation. This can lead to early osteoporosis or bone fractures.
Being overweight increases your risk of osteoarthritis, not only in your weight-bearing joints, but in your hands as well. Losing excess weight can be beneficial.
Osteoarthritis is common in older adults, earning the nickname “wear-and-tear” arthritis. Painful joints can inhibit physical activity, impair your basic activities of daily living, and keep you from getting a good night’s sleep.
With rheumatoid arthritis, the disease progression can destroy joints, leading to deformity in the fingers and wrist. Serious complications can arise in organ systems throughout the body, including:
- Rheumatoid nodules
- Sjögren’s syndrome
- Chronic obstructive pulmonary disease (COPD)
Obesity and smoking can exacerbate the lung and heart complications of rheumatoid arthritis. Cardiovascular disease is the leading cause of death with this condition.
Women with rheumatoid arthritis have more difficulty conceiving. It’s recommended that the condition be well-controlled for three to six months before attempting to get pregnant. Methotrexate must be discontinued for a minimum of three months before pregnancy due to the risk of birth defects. Uncontrolled rheumatoid arthritis during pregnancy raises the risk of preterm birth and low birth weight.
People with AS have an increased risk of vertebral fracture, which could injure the spinal cord and lead to a variety of neurological symptoms like weakness, numbness, or even paralysis. Severe misalignment of the spine from AS can also cause spinal cord compression, which is a neurological emergency.
People with AS are more likely to have inflammatory bowel disease and psoriasis. These are not thought to be direct complications of the disease, but instead due to shared genetic factors.
Complications from the inflammation lupus causes can affect any number of areas in your body, including your skin, heart, lungs, kidneys, blood, and brain.
If you get pregnant while you have lupus, you’re more likely to have a miscarriage, high blood pressure during your pregnancy, and preterm birth. Having your disease under control before you get pregnant helps reduce these risks.
The high uric acid levels in long-term, untreated gout can lead to kidney stones. If you have poor kidney function, you are also at risk of acute uric acid nephropathy (AUAN) with a rapid deterioration of renal function.
When to See a Doctor
The Arthritis Foundation recommends seeing the doctor for any joint symptoms that last for three days or more, or if you have several episodes of joint symptoms within a month.
There’s one other sign that you must honestly assess: Are your usual daily activities becoming much more difficult?
Arthritis signs tend to snowball. Joint pain and stiffness can lead to fatigue and malaise. Joint stiffness also affects the normal range of motion which, in turn, causes you to have more difficulty performing usual daily activities. And so it goes— each arthritis symptom impacts another. This is a signal that it is time to see your doctor.
After diagnosis, be sure to contact your doctor if you have any symptoms that are not typical of your usual symptoms, such as greater than usual redness or swelling. This is especially true if you develop a fever at the same time.
If you are having an arthritis flare-up that doesn’t clear up in a week with conservative therapy and rest, you should see your doctor.
Joint symptoms can come on suddenly or develop slowly over time. If you can’t match the symptom to a recent injury or it doesn’t clear up within a few days, see your doctor to start the diagnostic process. Identifying a specific type of arthritis is not always quick, as individual symptoms and symptom patterns can make diagnosing arthritis tricky. But early diagnosis and management is the best way to prevent joint damage and to preserve your quality of life.
- Shmerling RH. Patient education: Arthritis (Beyond the Basics). UpToDate. 2019.
- Das S, Padhan P. An Overview of the Extraarticular Involvement in Rheumatoid Arthritis and its Management. J Pharmacol Pharmacother. 2017;8(3):81-86. doi:10.4103/jpp.JPP_194_16
- Hunter DJ, Mcdougall JJ, Keefe FJ. The symptoms of osteoarthritis and the genesis of pain. Rheum Dis Clin North Am. 2008;34(3):623-43. doi:10.1016/j.rdc.2008.05.004
- Sankowski AJ, Lebkowska UM, Cwikła J, Walecka I, Walecki J. Psoriatic arthritis. Pol J Radiol. 2013;78(1):7-17. doi:10.12659/PJR.883763
- Waldman SD. Ankylosing Spondylitis. Atlas of Uncommon Pain Syndromes. 2014:230-232. doi:10.1016/b978-1-4557-0999-1.00096-4
- Maidhof W, Hilas O. Lupus: an overview of the disease and management options. P T. 2012;37(4):240-9.
- Saccomano SJ, Ferrara LR. Treatment and prevention of gout. Nurse Pract. 2015;40(8):24-30. doi:10.1097/01.NPR.0000469254.90496.ab
- El maghraoui A. Extra-articular manifestations of ankylosing spondylitis: prevalence, characteristics and therapeutic implications. Eur J Intern Med. 2011;22(6):554-60. doi:10.1016/j.ejim.2011.06.006
- James RA, Wedderburn LR. Modern management of juvenile idiopathic arthritis. Prescriber. 2016;27(6):37-43. doi:10.1002/psb.1472
- Vincent HK, Heywood K, Connelly J, Hurley RW. Obesity and weight loss in the treatment and prevention of osteoarthritis. PM R. 2012;4(5 Suppl):S59-67. doi:10.1016/j.pmrj.2012.01.005
- Crowson CS, Liao KP, Davis JM, et al. Rheumatoid arthritis and cardiovascular disease. Am Heart J. 2013;166(4):622-628.e1. doi:10.1016/j.ahj.2013.07.010
- Krause ML, Makol A. Management of rheumatoid arthritis during pregnancy: challenges and solutions. Open Access Rheumatol. 2016;8:23-36. doi:10.2147/OARRR.S85340
- Chaudhary SB, Hullinger H, Vives MJ. Management of acute spinal fractures in ankylosing spondylitis. ISRN Rheumatol. 2011;2011:150484. doi:10.5402/2011/150484