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Rheumatoid arthritis (RA) is an autoimmune disease. This prevalent type of chronic inflammatory arthritis is triggered when the immune system attacks healthy tissues in the body. The resulting inflammation leads to swelling and pain, particularly in the joints. Joint pain is one of the most common — and, in many cases, most challenging — symptoms of rheumatoid arthritis. In fact, joint pain is often the symptom that causes a person with RA to visit their doctor.
Each person living with RA may experience joint pain differently and to different degrees. Symptoms like pain typically depend on the severity of the disease and can appear or disappear at any time. Joint pain can also worsen during flare-ups and subside during periods of remission.
There are ways to manage and minimize joint symptoms of RA, both at home and with a rheumatologist’s help. Talk to your doctor if you start experiencing joint pain, even if you haven’t been diagnosed with RA. They can help determine the cause of your pain and work with you to find effective ways of managing it.
Joints affected by RA are often swollen, stiff, warm, reddened, and painful. Stiffness can be more intense earlier in the day, just after waking up (known as “morning stiffness”), or after a period of inactivity.
Several myRAteam members have described RA-related joint pain in many ways. As one shared, “Untreated, I like to say that someone has jabbed an ice pick into all the joints of my fingers and toes. I had a flare in my hips one time, and I would be in tears trying to get in and out of my car.”
Most members agree that their joint pain is at its worst during flares (periods of heightened disease activity).
One member experienced joint pain that worsened when the joint came into contact with objects: “My big toe is not red or hot to touch. It’s a little painful with walking, but there’s severe pain when it touches anything. When sleeping at night, I can’t let the sheet or blanket touch the joint — especially the inner side. I’ve been told by an orthopedic surgeon that I need my toe fused because of deformity.”
Another member described the severity of their joint pain and how it can be affected by the weather: “It hurts so bad before it rains — a throbbing ache at my finger joints. I get to the point with the pain that I want to bite the skin off my fingers to get rid of it. I know that makes no sense, but once the pain starts, that’s all I can think of.”
Many members have described how their joint pain can turn everyday tasks into monumental challenges. As one described, “I have such severe knee aches, it’s so depressing. Walking is a mission; driving is a mission.”
The progression of rheumatoid arthritis is typically categorized into four stages. The early stage of RA occurs when inflammation first affects the synovium in the joint. The synovium (or synovial membrane) is next to the cartilage in the joint. It produces synovial fluid — the liquid that lubricates the joints to allow for smooth movements.
When the synovium becomes inflamed due to RA, the joint swells up and becomes warm and tender. In some cases, the joint’s connective tissues (tendons and ligaments) are also affected by this inflammation, leading to pain. This inflammatory process also causes morning stiffness in affected joints and a reduced range of motion.
Joint pain and stiffness increase as RA progresses through the second, third, and fourth stages. In the second “moderate” stage, the cartilage becomes damaged, and rheumatoid nodules (lumps) form in the affected joints. The third “severe” stage starts destroying bone and can lead to joint deformity. In the final “end” stage of RA, the process of inflammation has run its course — the affected joints are still painful but no longer functional.
In most cases of RA, joint damage and pain will become worse as the disease progresses unless treatments can minimize disease activity.
Rheumatoid arthritis typically affects the small joints of the hands and feet first. The inflammatory process often spreads to joints in other parts of the body, including those in the shoulders, hips, ankles, elbows, wrists, and knees. RA tends to present in a symmetrical bilateral pattern, meaning it affects the same joints on both sides of the body.
Members of myRAteam have shared the different ways that RA-related joint pain has affected them. One member described having joint pain in every single joint in their body: “I’ve been trying to keep busy through the constant joint pain, stiffness, and swelling in ALL my joints.”
Another member was surprised to find that RA pain could affect joints in the rib cage. “For the last two days, my chest has been very painful where my ribs join the breastbone. When I touch the joint, it hurts,” they said. “The collarbone seems swollen where it meets the sternum. I have been dealing with RA for 16 years and never thought it could affect the ribs.”
One member was similarly surprised to learn that their jaw had been affected by RA: “From the normal joint aches — feet, knees, wrist, hands, shoulders to now my ear-jaw joint — I am so over all the joints in pain with this RA.”
A member described how their rheumatoid arthritis pain can spread unpredictably during a flare. They said, “My flares also go from joint to joint, from one day to the next. My left shoulder will hurt so badly; then the next day, my left hip; then the next day, my right shoulder. Very weird. The pain will be so intense, then it just goes away.”
Many members related to this experience.
RA treatment can vary greatly from person to person, depending on the disease’s progression and a person’s unique symptoms. Treating RA is often the first step to preventing and managing joint pain. When these treatments do not provide relief, your doctor may recommend other joint pain management medications and techniques.
In the early stages, the goal of RA treatment is to slow down the disease aiming for clinical remission. Slowing disease progression may help relieve the painful joint symptoms of RA.
Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate may help preserve joints and reduce joint pain by suppressing immune system activity and reducing inflammation. If RA continues to progress, biologic medications can often be added to the treatment plan.
Corticosteroid injections can also help alleviate early-stage RA-related joint pain. These injections are administered directly into the affected joint and can provide delayed but long-lasting relief. Oral corticosteroid medications such as prednisone are especially helpful for short-term use to treat aggressive flares.
Non-steroidal anti-inflammatory drugs (NSAIDs) can alleviate some joint inflammation and reduce pain. These medications are available over the counter and as prescriptions in stronger doses.
Another member recommended numbing gel to help relieve painful joints. “You may want to try massaging a numbing gel into those pesky joints,” they shared.
When RA progresses to the severe and end stages, doctors often recommend surgical procedures for joint pain management as a course of treatment. Although recovery can be challenging, surgery can often provide significant relief from joint pain. As one member shared, “I had the middle joints of both middle fingers replaced last September. If I ever have joint replacement in other fingers, I probably won’t do both hands at the same time. Recovery was slow, and I was in physical therapy for more than four months. On the plus side, my joints feel much better.”
Adding complementary therapies to your treatment plan — including joint protection, physical and occupational therapy, and certain lifestyle habits — can also help reduce and manage joint pain.
Protecting your joints from wear and damage can help you avoid making the inflammation and pain any worse. Taking breaks to rest a joint is preferable to overusing a joint and exacerbating discomfort. Although it’s also important to move and stretch the joints, be sure to allow for periods of rest in between.
Your doctor may recommend specific therapeutic exercises tailored to your unique needs and symptoms. A physiologist will design the exercises to help you achieve a certain goal — in this case, decreasing pain and stiffness.
Range-of-motion exercises relieve stiffness in the affected joints and help them become more flexible. You may be advised to repeat certain motions in your hands, feet, or other stiff joints. These exercises should be performed regularly to ensure gradual but consistent progress.
An occupational therapist may recommend using assistive devices to help you accomplish everyday tasks without causing pain or putting additional stress on your joints. These can include buttoning aids to help with dressing, reachers to get items from high or low shelves, and handrails in the bathroom.
For immediate at-home pain relief, you may want to try hot and cold packs. A hot pack can alleviate muscle spasms and improve blood flow. Cold packs can help reduce inflammation. These methods won’t affect your underlying rheumatoid arthritis, but they are a nonpharmacological way to manage joint pain caused by RA.
One myRAteam member said they swear by massage and essential oils to relieve joint pain: “I will massage my hand joints (or any joint, for that matter) with essential oils, and in moments, the pain eases.”
One member reported combining compression gloves (also known as arthritis gloves) for finger pain with a heating pad for neck pain: “I have pain and swollen joints in two fingers. Wearing compression gloves helps and keeps them warm. I also have some neck pain. Lying down for 10 minutes with a heating pad helps.”
Tracking your symptoms and communicating with your rheumatologist and health care team can help you form the ideal treatment plan for your joint pain.
On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 192,000 members come together to ask questions, give advice, and share their experiences with others who understand life with RA.
How does RA joint pain feel to you? Do you have any tips for managing joint pain? Share your thoughts and tips in the comments below or by posting on myRAteam.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
