Rheumatoid Arthritis

Original symptoms of rheumatoid arthritis and visiting a GP

Rheumatoid arthritis (RA) is a chronic inflammatory disease mainly affecting the joints, but it can affect other parts of the body too. The disease usually starts slowly, and symptoms may come and go over months or even years. However, severe symptoms can affect people quite suddenly. The sooner RA is diagnosed and treated the better.

RA can be hard to diagnose at first. GPs may suspect some form of arthritis but they often refer patients to a rheumatologist to make a specific diagnosis. This doesn't always happen. One woman consulted her GP about her painful swollen knee and he told her to go away and lose some weight.

Another woman developed a stiff neck. The next week her legs felt stiff. She consulted her GP, who told her to take some painkillers. Her condition got no better and eventually she was referred to a consultant who did blood tests and diagnosed RA (see 'Referral to the rheumatologist, tests and receiving the diagnosis').

RA often starts in just a few joints, such as the hands or feet. People may also notice that they feel a bit stiff in the morning, and they may experience flu like symptoms. One man set out for a run one morning and found his ankle swollen and painful, and later other joints hurt. He ached all over and felt 'absolutely washed out'.

Another person realised that something was wrong when her young nephew asked her to explain why she was 'walking down the stairs like a baby.' She also noticed that she had pains in her feet and found she was waking in the morning with stiff hands.

In many people it began with minor symptoms. One woman said that at first she noticed that her fingers felt sore, as though she had chilblains. Another said the disease started with a pain in her small toe. The GP prescribed an antibiotic, thinking it might be an infection. Six months later she developed pain in other joints.

Another woman had pains in her wrist which slowly got worse, making it hard to write letters. She visited her GP on several occasions and was prescribed ibuprofen, but as symptoms worsened she found difficulty sleeping and getting up in the morning. A further visit to the GP led to a referral to a specialist and she was relieved to get a diagnosis.

A 37 year old woman recalled that when she was 27 she had developed a pain in her elbow. Her GP thought she had pulled a tendon. The next week she developed a pain on the ball of the foot. The GP thought she had pulled a muscle. Two weeks later the pain seemed to be spreading to other joints, and a different GP decided to send her to the hospital for blood tests.

One person noticed that something was wrong when her fingers 'locked' as she was lifting a baby out of a cot. Another person became worried when he found it hard to get up from the floor. Someone else noticed a lump on his painful wrist.

Some people delayed going to see a GP. One woman, for example, had pains in her elbows, wrists, feet and hips for over two years, but didn't consult her doctor because she had nothing specific to show him. She finally consulted her GP when she could no longer play badminton.

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Other people developed severe symptoms of RA quite suddenly and had to seek urgent help (see 'Referral to a rheumatologist'). For example, one man developed an excruciating pain in his left arm and his right hand, so consulted his GP who was 'confused' by his symptoms and suggested painkillers. By the end of the week all his joints had 'stiffened up' and he could neither wash nor dress himself. He also sweated profusely and was severely sick.

Another man developed a 'tremendous pain' in his left ankle. He couldn't sleep, couldn't walk, and was in tears with pain. His wife called the GP, who gave him something to 'knock him out' and a large dose of steroid.

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One woman was shocked at the speed in which her symptoms developed. She had severe pains in her wrists and knees when she woke up in the morning, and couldn't understand why she was 'almost back to normal' by the evening.

The GP diagnosed some people with related conditions. One man was diagnosed with polymyalgia rheumatica and was treated for two years with steroids. He reduced the dosage but the symptoms persisted so the GP referred him to a specialist. He regretted not going to the GP sooner.

Children sometimes develop RA, and this is known as Juvenile Chronic Arthritis. A woman of 38 described how her Juvenile Chroinic Arthritis began in 1964. She complained of pain, developed a rash and had a high fever.

NICE issued guidance on Rheumatoid arthritis: the management of rheumatoid arthritis in adults in Feb 2009. It includes information for GP’s on when a person should be referred to a specialist and initial tests to conduct.

Last reviewed August 2016.

Last updated March 2012.

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