Early Signs of RA

Fatigue. One of the most common symptoms of several autoimmune diseases is fatigue; RA is no exception. You may experience fatigue before any other symptoms become obvious. In a 2013 survey of more than 1,000 RA patients in the U.S. (conducted by HealthUnion), fatigue was exceeded only by hand/wrist pain as one of the most significant initial symptoms of RA in 56.3 percent and 69.6 percent of survey respondents, respectively.

Morning stiffness. People with RA often experience early morning stiffness that lasts for hours. Stiffness may also occur throughout the day following periods of stillness or inactivity. Osteoarthritis may also cause morning stiffness; however, it will usually last 30 minutes or less.

Joint swelling and tenderness. Mild inflammation which accompanies stiffness may cause joints to appear larger than normal. The inflammation and swelling may also make joints feel warm to the touch and appear red. However, joint swelling may be so subtle as to make it difficult to identify, especially in obese patients.

Joint pain. The pain of early RA frequently involves specific joints of the hands or feet, including the metacarpophalangeal joint (MCP) at the base of each finger, the proximal interphalangeal joint (PIP), or the metatarsophalangeal joint (MTP) at the base of each toe. Keep in mind, however, that early RA pain is not limited to the hands and feet; larger joints may be involved.

Decreased range of motion, numbness, or reduced grip strength. Inflammation can affect tendons and ligaments as well as synovium, restricting range of motion, fluidity of motion, or physical function. Inflamed tendons may put pressure on nerves leading to numbness or weakness. In the 2013 survey mentioned above, 39.9 percent of respondents included reduced grip strength as an early symptom of RA, while 32.7 percent noted general weakness.

Low-grade fever. Often accompanied by general malaise, and in the presence of other symptoms, a low-grade fever may be an early warning sign of RA or a flare-up. However, a temperature above 100°F (38°C) is more likely to signal some other illness or, possibly, an infection.

Abnormal laboratory results. Studies show that anti-cyclic citrullinated peptide (anti-CCP) antibodies may be detected in healthy individuals years before the clinical onset of RA. Most, but not all, people with RA test positive for rheumatoid factor (RF). Nonspecific inflammatory markers, such as erythrocyte sedimentation rate (ESR or sed rate) or C-reactive protein (CRP), are often elevated, but test within normal ranges in about 60 percent of patients with early RA. Additional abnormal blood tests may include high platelet count, low albumin, raised alkaline phosphatase (a liver enzyme), or normocytic-normochromic anemia.

Firm lumps of tissue located under the skin. Rheumatoid nodules tend to grow close to joints affected by RA, such as elbows or wrists. They may be as small as a pea or grow to the size of a walnut. Nodules can also form on vocal cords, or appear in the lungs, heart or other organs.

Extra-articular symptoms. Patients with early RA may develop vasculitis, inflammation of the blood vessels, or serositis, which involves inflammation of the tissue lining the lungs (pleura), heart (pericardium), or inner lining of the abdomen (peritoneum). Pleurisy (inflammation of the lungs) can cause chest pain when you breathe.

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What are Early Signs of Rheumatoid Arthritis?

Does Yoga Help RA?

The short answer is yes, research has demonstrated positive benefits of yoga for persons living with RA. In preparation for writing this article, I conducted a quick search (using terms rheumatoid arthritis and yoga) of research studies indexed in PubMed and came up with 25 entries. It was interesting that among those 25 entries, I discovered:

• a small number of the published articles were papers that detailed the protocols for future research studies (e.g., Evans, 2011; Middleton, 2013);
• a small number of the studies were pilot studies conducted to investigate the feasibility of conducting larger studies (e.g., Evans, 2010); 
• not many studies have been conducted which specifically investigate yoga and RA, with less than a handful being randomized, controlled studies; and 
• a significant number of the articles were actually reviews or meta-analyses of the small number of completed studies published within a certain time period (e.g., Telles, 2012).

How does yoga benefit persons with RA?

Here are some of the reported benefits of yoga in patients with RA seen during select clinical trials of various methods, outcomes, measurements, and duration.

Yoga helps to decrease:

• Disability
• Pain
• Depression
• Anxiety
• Fatigue
• Rheumatoid factor levels (reduced in both men and women, but remained above normal in women; Telles, 2011)
• C-reactive protein levels (primarily in women; the average levels in male participants more than doubled; Telles, 2011)

Yoga helps to improve:

• Range of motion and balance
• Chronic pain acceptance
• Mood
• Energy
• Relaxation
• Sleep quality
• Self-efficacy and confidence
• Vitality and general health
• Mindfulness
• Daily functioning
• Quality of life
• Hand grip strength (males only in one study; Telles, 2011)

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Benefits of Yoga for RA Patients

Can RA Cause Changes in Your Voice?

According to a new literature review in the journal Autoimmune Diseases, the prevalence of laryngeal symptoms of RA has risen from up to 31% of RA patients in 1960 (Lawry, 1984) to 75% by the end of the 20th century (Hamdan, 2013).  At least a portion of this significant increase is likely due to increased awareness and better clinical diagnosis.

Symptoms of larynx involvement caused by RA include odynophagia (painful swallowing), foreign body sensation, dysphagia (difficulty swallowing), sore throat, lump sensation in the throat, change in voice quality (e.g. hoarseness, breathiness, vocal fatigue), referred otalgia (earache), and respiratory symptoms (e.g. shortness of breath, decreased exercise tolerance, stridor, dyspnea, respiratory distress). In rare cases, patients with RA may also present with symptoms of croup.  Patients may also be asymptomatic.

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Hoarseness and Shortness of Breath: Is Your RA the Cause?

Depression and Anxiety in RA Patients

Results from a 2012 study support growing evidence of high rates of symptoms of anxiety amongst people diagnosed with RA.  However, risk factors for anxiety, unlike for depression, have not been systematically examined in relation to RA.  Authors caution that lack of consistent cut-off points in different measurement scales of anxiety and depression make prevalence estimates and meta-analytic studies challenging (Covic, 2012).

Anxiety is also common in MS and I have experienced more anxious feelings as my disease has changed and progressed.  It manifests primarily as irritability and impatience with others.  My neurologist prescribed a medication to use as needed when generalized anxiety arises which has been a blessing.

What is interesting is that my rheumatologist has not asked me about anxiety or depression.  I recently received a copy of my medical records and notice that my rheumy has made note of my mood and demeanor.  For one visit she listed “cheerful” and another “mood appropriate.”  We have never discussed my depression or anxiety. 

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Depression and Anxiety More Common When Living with RA