By Douglas Roberts, MD, Special to Everyday Health
Medically Reviewed by Alexa Meara, MD
Could your hand or foot pain be caused by rheumatoid arthritis (RA)?
RA is a serious autoimmune disease that is much different from osteoarthritis, the type of arthritis that usually occurs as we age. Rheumatoid arthritis can strike at any age, and if you don't get diagnosed and treated, you could develop joint damage and painful, crippling deformity.
A devastating disease that can severely damage your joints, RA also affects other organs and reduces your life expectancy. Newer treatments are very successful at reducing joint pain and damage, and remission is a real possibility. But early treatment is essential to avoid permanent joint damage and disability.
Diagnosing 6 Common RA Signs and Symptoms
Sometimes it can be difficult to tell whether your symptoms are those of RA or the more common wear and tear arthritis called osteoarthritis (OA). Either diagnosis should be confirmed by someone who is an expert in arthritic diseases, usually a rheumatologist. Here are six rheumatoid arthritis early symptoms and how they differ from signs of OA.
1. Usually with RA, one or more of your finger knuckle joints will be swollen. The swelling or inflammation is more likely to be in the middle or large knuckles of your hands not the knuckles at the tips of your fingers next to your fingernails. It is often in the same joints on both hands (the swelling is symmetrical). The swelling does not feel "bony," but rather tender and slightly soft. With RA, you may also feel warmth and notice redness over the inflamed joint.
2. At least one of your middle or large knuckles has been swollen and painful for more than six weeks. If there's no clear reason or explanation for this, it could be a sign of RA. Large joints, such as your ankles, knees, shoulders, or elbows, may be involved, but you must have swelling and pain in at least two joints to be diagnosed with rheumatoid arthritis. On the other hand, swelling or pain in your small fingertip knuckles, at the base of your thumbs, and in your big toe joints will more often be due to OA.
3. The balls of your feet are also targets for RA. Often, people with rheumatoid arthritis experience a feeling of "walking on golf balls" or swelling under the foot, especially first thing in the morning when getting out of bed. This pain will feel different from pain caused by a bunion. Pain from a bunion is usually at the base of the big toe, and feels worse when you wear tight shoes.
4. You just don't feel well, and you may notice bumps on your elbows. With RA, you may have flu-like symptoms, such as low-grade fevers, stiffness, and fatigue from inflammation. Occasionally, small tender bumps or nodules under the skin will develop with RA, often near the back of the elbow. These are called rheumatoid nodules.
5. Your joints are particularly stiff for more than an hour in the morning. With rheumatoid arthritis, you may find it difficult to completely make a fist. You may have unusually tender swelling on the top of your wrists along with stiffness. If your elbows are involved, it may be difficult for you to straighten them completely. Usually, you won't have swelling or pain in your hip joints early in the course of RA. Painful hip joints more often are due to OA, and most people feel the pain in the front of the hip or in the groin region.
6. Certain blood tests may help determine whether you have RA. These are usually ordered by your health provider, but there are companies that allow you to order these tests yourself (Hint: Google search order your own lab tests). Four important tests are usually ordered for an RA diagnosis. Two measure proteins in your blood called antibodies: Rf (rheumatoid factor) and CCP (anti-cyclic citrullinated peptide). The other two measure inflammation: ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein). With RA, at least one Rf or CCP test must be positive and at least one CRP or ESR test must be abnormal.
RELATED: Don't miss these lifestyle tips from people who have RA. Find answers on Tippi.
ACRs Point System to Confirm an RA Diagnosis
The American College of Rheumatology (ACR) has developed a point system to help confirm the diagnosis of rheumatoid arthritis; your score has to be at least six points for a definitive diagnosis of RA. Here's a simplified summary of how the points are measured:
The number of Swollen or Tender Joints Can Count for up to 5 Points
- Two or more large joints (1 point)
- One to three small joints (2 points)
- 4 to 10 small joints (3 points)
- 10 joints with at least one small joint (5 points)
Blood Tests Should Be Positive, and Give Additional Points
- At least one positive Rf or CCP (2 to 3 points depending on how high)
- And at least one abnormal CRP or abnormal ESR (1 point)
One additional point is added if you've had symptoms for at least six weeks. Many doctors realize that it's possible to have RA and not meet all the criteria. You should have a detailed discussion with your doctor about whether you should start treatment. Although current RA drugs are very effective, they sometimes have serious side effects.
RA Goals: Early Detection and Treatment
We now know that some forms of RA are very aggressive, and much permanent joint damage can occur within the first 12 months. RA cannot be cured yet, but joint damage can be slowed and sometimes stopped. Understanding the difference between OA aches and pains and early signs of RA is critical to saving your joints from painful damage and disability. If you're having trouble explaining your joint pain and possible arthritis symptoms to your doctor, try writing them down in a journal, or visit a website dedicated to pain management, such as my website, PainSpot.com.
Douglas Roberts, MD, has been practicing rheumatology since 1990. He is an associate professor of medicine at the School of Medicine at the University of California in Davis, and an attending physician at UCD Medical Center. He created the PainSpot.com website to help people with painful joints understand possible causes, and get help for serious arthritic conditions, such as rheumatoid arthritis.