The symptoms of rheumatoid arthritis (RA) begin gradually. It may be weeks or months before they are noticeable. Many people experience nonspecific symptoms, such as fatigue, malaise, loss of appetite and low-grade fevers. The joint symptoms begin with morning stiffness that may last an hour or more. Joint pain, stiffness and swelling that occurs symmetrically (same joint on both sides of the body) are also characteristic of RA.

Some people develop rheumatoid nodules, which are painless lumps under the skin that form at pressure points, such as feet, hands and elbows. Some patients have dry eyes and mouth, which in some cases may be overlap symptoms from another autoimmune condition known as Sjogren's syndrome, or eye inflammations such as uveitis.

RA causes some particular symptoms in each of the joints it affects. Some of the symptoms in specific joints include:

• Hand. Joints in the fingers and hands are usually the first joints affected by RA. They may become red, swollen and tender. Nodules may form that restrict hand movement. Gripping may become more difficult and the thumb may lose mobility. As RA progresses, characteristic problems include the tightening of the tendon on the back of the hand so it becomes prominent and deformities where the fingers shift toward the little finger (ulnar drift).
  
  
• Wrist. In early RA, the wrist may not bend back easily. In later stages, inflammation to the joints and tendons in the wrist can make the tendons rupture. Pressure on the median nerve in the wrist may cause carpal tunnel syndrome, a painful wrist condition.
  
  
• Elbow. Inflammation and swelling at the elbow can compress nerves and cause numbness or tingling in the fingers.
  
  
• Shoulder. In later stages of RA, some inflammation may limit motion and cause shoulder pain, including the condition known as frozen shoulder.
  
  
• Foot. The joints in the feet are also among the first affected by RA. There may be tenderness and pain in the joint at the base of the big toe, which may form a bunion. Redness, swelling and heel pain may also occur.
  
  
• Ankle. Inflammation in the ankle joint may compress nerves and cause numbness or tingling in the feet.
  
  
• Knees. RA may make it difficult to bend the knee and cause swelling. A fluid-filled sac called a Baker's cyst may form at the back of the knee. Progression of RA degenerates cartilage and weakens the ligaments. This may create the sensation of knee instability.
  
  
• Hips. Later stages of RA may inflame the hips, making it painful to walk.
  
  
• Neck (cervical spine). Most people with RA in the neck have had the disease for 10 years or more. Inflammation can cause a stiff neck and inability to bend or turn the head. Later inflammation in the neck can cause serious pressure on the spinal cord, which may result in arm pain, loss of coordination and loss of bowel and bladder function.
  
  
• Windpipe. Nearly one-third of people with RA have inflammation of the cricoarytenoid joint in the neck near the windpipe (trachea), which can cause difficulty breathing and hoarseness.

If RA moves to other body systems, it may cause the following symptoms:

• Lungs. Inflammation of the lung lining (pleuritis) may cause chest pain with deep breathing or coughing.
  
  
• Cardiovascular system. Nearly all RA patients have anemia, a lowered level of red blood cells, which can cause fatigue. RA in the heart may cause chest pain when leaning forward or lying down, although this is rare. Inflammation in blood vessels (vasculitis) can slow blood supply to tissues. This may produce symptoms in different locations, depending on the affected blood vessels. It may first be visible as leg ulcers and black areas around the nail beds.
  
  
• Nervous system. RA in any part of the nervous system may cause numbness, weakness or tingling.