March 26, 2023

Kristen Gasnick, PT, DPT, is a medical writer and a physical therapist at Holy Name Medical Center in New Jersey.
David Ozeri, MD, is a board-certified rheumatologist from Tel Aviv, Israel specializing in arthritis, autoimmune diseases, and biologic therapies.
Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that results when your body produces antibodies to attack its own joints. These antibodies may also attack other parts of your body, causing widespread inflammation and cell damage affecting the skin, eyes, digestive system, lungs, and heart.
This article will review some of the more unusual and uncommon symptoms of rheumatoid arthritis other than joint problems to help recognize and diagnose rheumatoid arthritis.
While rheumatoid arthritis most commonly causes joint pain, inflammation, and swelling, systemic symptoms such as fatigue can affect the whole body. Inflammation from rheumatoid arthritis can also target other systems of the body, resulting in a variety of different symptoms. These are known as extra-articiular manifestations.
The most common symptoms of rheumatoid arthritis include:
Rheumatoid arthritis can affect the joints of the neck and jaw, which can predispose people with rheumatoid arthritis to develop sleep apnea. This can lead to daytime tiredness, interrupted sleep, and snoring due to blocked airways while asleep.
Skin problems from inflammatory changes that can cause rashes, clusters of bumps or hives, and discolored patches of skin are common with RA.
The most common skin condition with RA is rheumatoid nodules, small bumps that develop over bony areas like the heels, elbows, knees, forearms, and fingers. They develop in approximately 25% of all patients with rheumatoid arthritis.
Rheumatoid vasculitis is rare but serious. It occurs when inflammation spreads to the blood vessels, causing numbness, tingling, or pain in the hands and feet. It also causes skin rash, and can affect areas of the body like the brain, heart, lungs, kidneys, and gastrointestinal tract.

Breathing problems can result from inflammation of the lungs, which can cause conditions like pulmonary fibrosis, interstitial lung disease, and pleuritis in 5% to 30% of patients with rheumatoid arthritis. These conditions can cause shortness of breath, a dry cough, and chest pain.
Inflamed joints that affect nearby nerves can lead to nerve damage or compression that can result in symptoms of numbness and tingling, most commonly in the hands, feet, and limbs. Numbness and tingling can result from specific conditions associated with rheumatoid arthritis, including carpal tunnel syndrome, Raynaud’s disease, and peripheral neuropathy.
The same bacterium that causes gum disease (gingivitis) is believed to play a role in the development of rheumatoid arthritis in susceptible patients. Gum disease results from poor oral hygiene habits from not brushing or flossing properly, leading to inflamed gums that are painful, swollen, and susceptible to bleeding.
Secondary Sjögren's syndrome, which can cause dry mouth, is also common in rheumatoid arthritis. It occurs when inflammation attacks the salivary glands. There is no cure for it, but it can be treated with biologics.
Because rheumatoid arthritis causes painful, inflamed joints, muscle wasting and weakness is common as people with RA will often avoid moving their painful joints. This loss of muscle mass may alter body composition and increase total body fat in sedentary individuals. 
Inflammatory changes that occur with rheumatoid arthritis can also attack the eyes. When it does, it results in longer duration of symptoms and includes conditions like keratoconjunctivitis sicca (dry eye syndrome), episcleritis(red eyes), scleritis (swelling of the whites of the eyes), and keratitis (inflammation of the cornea). Symptoms of these conditions include dry, itchy eyes, eye pain, eye redness, blurry vision, and sensitivity to light.
Rheumatoid arthritis is associated with sleep disorders and depression and anxiety, which can make falling asleep more difficult at night. Risks of depression and anxiety increase as RA progresses, and this can lead to long-term disturbed sleep.
Chronic inflammation from autoimmune conditions like rheumatoid arthritis can also cause chronic inflammation in the brain linked to dementia, Alzheimer's disease, and forms of mental illness. The same inflammatory proteins that are elevated in patients with rheumatoid arthritis are also elevated in patients with Alzheimer's disease.
Treatment with disease-modifying antirheumatic drugs (DMARDs) to reduce these inflammatory proteins may be able to prevent or slow the development of Alzheimer's disease and related mental health conditions.
Medications for RA have a variety of neurological side effects that can cause cognitive issues like psychosis (delusions and hallucinations), difficulty concentrating, and memory loss. This is due to the medications' inflammatory effects.
The most common digestive issues related to rheumatoid arthritis are liver dysfunction, enlarged liver and spleen, cirrhosis (scarring of the liver), and pancreatitis (inflamed pancreas).
Up to 13% of patients with rheumatoid arthritis also develop amyloidosis, in which an abnormal buildup of proteins damages the liver and intestines, causing abdominal pain, malabsorption, and chronic diarrhea.
Rheumatoid arthritis is diagnosed based on a combination of symptoms and blood work. RA will typically affect the same joint on both sides of the body and cause pain, swelling, and inflammation for more than six weeks.
Blood work will typically also reveal elevated inflammatory markers, including increased levels of rheumatoid factor, C-reactive protein, and erythrocyte sedimentation rate. X-rays are often performed to examine joints for signs of bone damage and joint space narrowing.
If you have been experiencing joint pain, stiffness, and swelling for more than one month, especially in addition to other systemic symptoms, schedule a visit to talk with your healthcare provider. Early diagnosis and treatment of rheumatoid arthritis is important for accurately diagnosing the condition and preventing it from progressing.
Medication is the gold standard treatment to decrease the inflammatory autoimmune response with rheumatoid arthritis. Drugs for rheumatoid arthritis include DMARDs like methotrexate, biologics like tumor necrosis factor (TNF) inhibitors, and Janus kinase (JAK) inhibitors. Glucocorticoids (steroids) are also used for short-term management of joint inflammation and swelling for up to three months in the initial treatment of rheumatoid arthritis.
Rheumatoid arthritis is an inflammatory autoimmune form of arthritis that attacks the joints in a symmetrical fashion, causing prolonged joint pain, inflammation, and swelling. While painful and swollen joints is the primary symptom of rheumatoid arthritis, inflammation can also affect multiple other systems of the body.
This includes uncommon symptoms like hearing issues, snoring, skin rashes, breathing problems, numbness and tingling, gum disease, increased body fat, eye irritation, disrupted sleep, mental health conditions, cognitive issues, and digestive problems.
Treatment with medications like glucocorticoids, DMARDs, biologics, and JAK inhibitors can help lower the autoimmune response to decrease inflammation throughout the body, helping to decrease joint pain and other symptoms.
Symptoms other than joint pain, swelling, and inflammation are often indicators of a complication or progression of rheumatoid arthritis. Staying on top of your medications and following healthy lifestyle habits can help you manage your rheumatoid arthritis and keep inflammation under control.
The most common symptoms of rheumatoid arthritis are joint pain, inflammation, redness, stiffness, and swelling.
Other forms of arthritis that are also autoimmune conditions can be mistaken for arthritis, such as osteoarthritis, psoriatic arthritis, systemic lupus erythematosus, and sarcoidosis.
A rheumatoid arthritis flare-up will often cause an increase in joint pain, swollen and tender joints, joint stiffness, severe fatigue, and a general feeling of being unwell.
Centers for Disease Control and Prevention. What is rheumatoid arthritis?
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By Kristen Gasnick, PT, DPT
Kristen Gasnick, PT, DPT, is a medical writer and a physical therapist at Holy Name Medical Center in New Jersey.

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