In majority of the patients the onset is gradual and their is slow development of signs and symptoms over weeks to months. The symptoms include:


I. Articular (joint) symptoms

  • Pain and symmetrical swelling of a number of peripheral joints (hands, wrist, elbow, shoulder, ankle etc.). Initially pain is experienced only on motion but later it may be present even at rest.
  • Early morning stiffness in the joints which lasts for more than one hour.
  • Joint is red, swollen and warm to touch because of inflammation.



  • Weakness and loss of mobility of joints.
  • The swelling of the proximal interphalangeal joint (finger joints) gives the finger a “spindled appearance” and swelling of metatarsophalangeal joint (joint between toes and foot) results in broadening of the front part of the foot.
  • Difficulty in sleeping and depression may be the other associated symptoms.


II. Extra-articular (away from joint) symptoms


  • Systemic symptoms :
    • Low grade fever and sweating
    • Generalized fatigue and weight loss
    • Susceptibility to infection


  • Lumps or rheumatoid nodules : It is a complex collection of cells surrounded by lymphocytes (defense cells) in response to inflammation. They develop usually on the outer surfaces of the arms and elbows but may also form at pressure points on the feet and knees.


  • Fluid collection : RA can stimulate the accumulation of fluid in various areas of the body. Often fluid accumulates around the knee resulting in a swelling behind the knee called as Baker’s cyst. Increased pressure caused by flexing (bending) the knee can result in rupture of the cyst in the calf causing pain in calf, swelling, tenderness and pitting edema.



  • Heart disease
    • Inflammation of the membranes surrounding the heart  resulting in chest pain and difficulty in breathing.
    • Inflammation of coronary blood vessels and conduction defects may occur.


  • Lung disease
    • Rheumatic nodules in the lungs.
    • Pleural effusion (a collection of fluid in the membrane covering the lungs) This can result in chest pain, cough, breathlessness.
    • Inflammation of smaller airways.


  • Ocular (eye) disease
    • Inflammation of sclera. It may affect vision and cause head pain.
    • Sjogren’s Syndrome : It is seen mostly in women. It is caused by lymphocytic infiltration of tear and salivary glands which leads to impaired secretion of tears and saliva respectively, resulting in dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca).


  • Musculoskeletal disease
    • Muscle wasting because of immobility of the joints
    • Osteoporosis (loss of bone matter result in thinning of bones).


  • Hematological (blood) disease
    • Anemia (deficiency in number of red blood cells) which reduces the supply of oxygen to tissues and organs, causing the patient to feel tired, look pale and become short of breath.
    • Vasculitis (inflammation of the blood vessels). This can cause impaired blood circulation which affects nerve function, resulting in numbness or tingling sensations.


  • Neurological
    • Peripheral neuropathy resulting in mild ‘glove and stocking’ sensory loss.
    • Entrapment neuropathies result because of compression of peripheral nerve by the thickened synovial membrane. Patient may complain of numbness, tingling and sensory loss along the course of the nerve involved.
    • Cervical cord compression.


  • Lymphatic
    • Splenomegaly (enlargement of the spleen).
    • Felty’s syndrome presents with splenomegaly, lymphadenopathy (enlargement of glands), weight loss, skin pigmentation, dryness of eye and mouth, vasculitis, leg ulcers and repeated infections.