Understanding Rheumatoid Arthritis: Symptoms and Management

Rheumatoid arthritis is a chronic autoimmune disease that primarily affects the joints but can also impact the entire body. Symptoms typically appear gradually, and early signs may be confused with other joint issues, leading to delayed diagnosis. Early recognition of symptom characteristics is crucial for treatment effectiveness.

This disease is characterized by symmetrical joint involvement, meaning that the same joints on both sides of the body become inflamed simultaneously. The severity of symptoms varies from person to person; some patients may experience alternating flare-ups and remission periods. Prolonged inflammation can lead to joint structural damage and functional impairment, so understanding the pattern of symptom changes can aid in early intervention.

Early Symptoms and Signs

Early symptoms may be mistaken for general arthritis or muscle fatigue, but their unique manifestations include:

• Low-grade fever (persistent low-grade fever below approximately 37.5°C)
• Unexplained fatigue that does not improve with adequate rest
• Mild swelling and tenderness in the small joints of the hands (such as the metacarpophalangeal joints)
• Joint stiffness lasting more than 30 minutes upon waking in the morning

About 20-30% of patients may experience unexplained weight loss or appetite changes before joint symptoms appear. These systemic signs are often overlooked, but should raise suspicion when combined with symmetrical joint symptoms.

Common Symptoms

Characteristic Joint Symptoms

Typical symptoms present the "three symmetry principle": bilateral symmetry, proximal joints prioritized, and small joints affected. Commonly affected joints, in order, include:

• Metacarpophalangeal joints (where fingers connect to the palm)
• Metatarsophalangeal joints (where toes connect to the foot)
• Wrist and knee joints
• Shoulder joints and cervical vertebrae

The inflammatory process can cause swelling of the surrounding tissues (synovium, ligaments), with warmth and tenderness felt upon palpation. Prolonged inflammation may lead to joint deformities, such as "ulnar deviation" or "swan neck" deformities of the fingers.

Systemic Symptoms

More than 60% of patients will experience systemic symptoms, including:

• Persistent fatigue (affecting daily activity capacity)
• Low-grade fever (37.3-38°C) accompanied by mild chills
• Muscle weakness and decreased coordination
• Mild lymphadenopathy (in the neck or armpits)

When these symptoms worsen concurrently with joint symptoms, it indicates that the disease is in an active phase. Systemic symptoms may improve after disease control, but joint damage may be irreversible.

Disease Progression and Symptom Changes

During the active phase of the disease, patients may experience fluctuations in symptoms:

• Acute flare-up: Increased joint swelling, with morning stiffness lasting 1-3 hours
• Remission: Temporary improvement in joint mobility, but structural damage continues

Disease progression may lead to the following changes:

• Joint structural damage: Ligament laxity and bone resorption leading to joint displacement
• Functional impairment: Inability to perform fine motor tasks (such as buttoning a shirt)
• Secondary symptoms: Systemic complications such as dry eye syndrome or pulmonary fibrosis

About 25% of patients may develop rheumatoid nodules, usually located subcutaneously at the elbows or heels, reflecting the severity of the disease. Extra-articular symptoms may gradually appear after 5-10 years of disease progression.

When to Seek Medical Attention

Seek immediate medical attention if:

• Symmetrical joint swelling and morning stiffness persist for more than 6 weeks
• Friction sounds are heard during joint movement (crepitus)
• Unexplained weight loss exceeding 5% of body weight

Key distinctions from osteoarthritis include:

• Flare-up pattern: Rheumatoid arthritis presents with symmetrical flare-ups, while osteoarthritis often occurs unilaterally
• Duration of morning stiffness: More than 1 hour is considered an indicator of rheumatoid arthritis

If systemic symptoms (such as dry cough with difficulty breathing) occur, it may indicate lung involvement, and a comprehensive evaluation should be conducted immediately. Early diagnosis can reduce the risk of joint destruction by 30-50%, so symptom monitoring should be combined with clinical examination and blood index analysis.

 

Frequently Asked Questions

Does weather change exacerbate rheumatoid arthritis symptoms?

Changes in temperature and humidity may affect joint relaxation; some patients report increased pain or stiffness in damp and cold environments. Studies suggest that low atmospheric pressure or cold weather may increase the viscosity of joint fluid, and patients are advised to keep warm, use heat packs, or adjust indoor temperatures to alleviate discomfort.

Can dietary adjustments help alleviate inflammatory responses?

A diet rich in anti-inflammatory components (such as deep-sea fish, nuts, and olive oil) may help reduce symptoms. It is recommended to increase Omega-3 fatty acid intake and decrease refined sugars and processed foods to lower systemic inflammatory indices. Additionally, maintaining adequate vitamin D intake or sun exposure may improve bone health.

Do rheumatoid arthritis patients need long-term medication?

Currently, there is no cure for this disease, but disease-modifying antirheumatic drugs (DMARDs) or biologics can control inflammation and delay joint destruction. Physicians will adjust treatment plans based on the condition; some patients may reduce medication dosage after symptom relief, but regular follow-up is necessary to prevent relapse.

Does excessive rest exacerbate joint stiffness?

Prolonged inactivity may lead to joint stiffness and muscle strength deterioration. Patients are advised to engage in light joint activities during acute flare-ups and gradually perform strength training, such as aquatic exercises or physical therapy, after pain relief to maintain joint flexibility and function.

What is the "morning stiffness" phenomenon? How can it be improved?

Morning stiffness refers to the sensation of stiffness lasting more than 30 minutes upon waking, primarily due to increased viscosity of joint fluid. Relief methods include performing slow joint movements after getting out of bed, using heating pads, or taking anti-inflammatory medications as prescribed. Regular exercise can also extend the relief duration of stiffness symptoms.