What are the first signs of rheumatoid arthritis?

The first signs and symptoms of rheumatoid arthritis (RA) are usually pain and stiffness of more than one joint in your hands or wrists. Morning stiffness of your hands or wrists may last one hour or longer. Other commonly affected joints are the elbows, shoulders, ankles and knees. Another early warning sign is fatigue and weight loss.

Early signs can also be found in blood tests and joint imaging studies.

The average age range for first signs of RA is between 30 and 50 years old, though RA can happen at any point in your life.

The first signs and symptoms are more likely to be RA if you are at higher risk for RA.

• You may be at higher risk if you are a woman.
• If you have a family history of RA, it increases your risk significantly. About 40 to 60 percent of people who test positive for RA on blood testing have a family history of RA.
• Smoking is another big risk factor for RA.

If you have any of the early warning symptoms of RA, your doctor may look for early warning signs in your blood and joints. An antibody caused by RA, called anti-citrullinated protein antibody (ACPA), is found in about 50 percent of people with early RA.

A key finding is a joint imaging study that shows periarticular erosion (because other signs and symptoms of early RA can be caused by other diseases). Periarticular erosions, which change the structure and shape of the affected bone due to a more-than-typical breakdown of bone, are almost always a sign of RA. This early sign may not be seen on a plain X-ray, but may show up on an ultrasound or in MRI imaging.

Treatment with drugs called disease-modifying anti-rheumatic drugs (DMARDs) works best when started within the first 6 months of the early signs and symptoms of RA.