Clinical Immunology focuses on the immune system’s health. Learn about the diagnosis and treatment of allergies, autoimmune diseases, and immunodeficiencies.
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The symptoms of rheumatoid arthritis are distinct from other musculoskeletal conditions due to their pattern and origin. Because it is an immune disorder, the symptoms are often systemic, meaning they affect the whole body, not just the isolated joints. The hallmark of the condition is inflammation that is usually symmetrical—affecting the same joint on both sides of the body—and is accompanied by significant stiffness after periods of inactivity. Understanding the immune dysfunction helps explain why symptoms fluctuate and why they extend to organs like the eyes and lungs.
The most distinguishing symptom is symmetry. If the right wrist is swollen and painful, the left wrist is likely to be affected as well. This symmetry is a key clinical indicator of the systemic nature of the immune attack.
The disease typically begins in the small joints of the hands and feet. The metacarpophalangeal (MCP) joints and proximal interphalangeal (PIP) joints in the fingers are early targets.
As the disease progresses, it may spread to larger joints such as the knees, ankles, elbows, hips, and shoulders.
One of the defining symptoms is morning stiffness that lasts for a significant duration, typically longer than 30 minutes and often up to several hours.
This stiffness also occurs after any prolonged period of inactivity, such as sitting at a desk or riding in a car. The fluid in the joints thickens during rest, making movement difficult until the joint “warms up.”
Unlike mechanical pain which worsens with use and improves with rest, inflammatory pain in rheumatoid arthritis often improves with gentle movement and worsens after resting.
About a quarter of patients develop firm, flesh-colored lumps under the skin called rheumatoid nodules. These usually form near joints that receive pressure, such as the elbows.
In rare cases, the immune disorder affects the blood vessels, causing rheumatoid vasculitis. This can appear as small black dots around the fingernails or ulcers on the legs, indicating tissue damage from inflammation.
The immune system may attack the moisture-producing glands. This leads to severe dryness of the eyes and mouth, increasing the risk of dental decay and eye infections.
Inflammation can affect the white part of the eye (sclera), causing redness, pain, and sensitivity to light. This is a direct result of the immune disorder targeting collagen tissues in the eye.
Inflammation can affect the lining of the lungs (pleuritis) or the lung tissue itself (interstitial lung disease). Patients may experience shortness of breath or a chronic dry cough.
The lining around the heart can become inflamed, a condition known as pericarditis, which causes chest pain. This highlights the extensive reach of the immune disorder beyond the musculoskeletal system.
The swelling within the joints can compress adjacent nerves. Carpal tunnel syndrome is a frequent early symptom caused by inflammation in the wrist compressing the median nerve.
Rheumatoid arthritis can affect the top of the spine (C1-C2 vertebrae). Instability here can lead to neck pain and, in severe cases, neurological symptoms due to spinal cord compression.
Symptoms tend to occur in cycles known as flares. A flare is a sudden increase in disease activity where joints become swollen, painful, and warm to the touch.
Flares can be triggered by stress, overexertion, or infection. Understanding the signs of an oncoming flare—such as increased fatigue or subtle joint stiffness—is crucial for managing the immune disorder.
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During sleep, inflammation causes fluid to accumulate in the joint tissues. Without movement to circulate this fluid, the joints become stiff and swollen, taking time to loosen up after waking.
They are hard lumps that form under the skin, usually around pressure points like the elbows or knuckles. They are non-cancerous and are a sign of systemic inflammation.
Yes, as a systemic autoimmune disease, it can cause inflammation in the lungs, heart, eyes, and skin, leading to complications beyond joint pain.
A flare is a period of intensified symptoms. You may feel increased joint pain, swelling, heat in the joints, and extreme fatigue that makes daily tasks difficult.
Yes, during active inflammation or a flare-up, the body’s immune response can generate a low-grade fever along with general malaise and loss of appetite.
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