When Rheumatoid Arthritis Symptoms Are Serious

The signs and symptoms of rheumatoid arthritis can become serious, especially if RA goes untreated or under-treated. Serious symptoms can significantly affect quality of life and may get worse without medical attention.

This article discusses severe RA symptoms and how they develop. It also highlights potentially dangerous health complications related to rheumatoid arthritis—diseases and conditions that are more likely to develop in people who have RA.

Rheumatoid Nodules Affect Joint Function or Press on a Nerve

Experts estimate about 35% of people with RA develop rheumatoid nodules at some point.¹Tilstra JS, Lienesch DW. Rheumatoid Nodules. Dermatol Clin. 2015;33(3):361-371. doi:10.1016/j.det.2015.03.004 PMID: 26143419 Nodules are solid, firm, round lumps of inflamed tissue. Ninety-nine percent of nodules form just below the skin at pressure points near joints, particularly at the elbows, fingers, and feet.

Nodules tend to be between 2 and 5 cm in diameter.¹Tilstra JS, Lienesch DW. Rheumatoid Nodules. Dermatol Clin. 2015;33(3):361-371. doi:10.1016/j.det.2015.03.004 PMID: 26143419 Over time, nodules may get bigger or smaller, or go away completely. While most nodules are harmless, treatment may be required if a nodule:

• Prevents a joint from working normally. Such a nodule may cause pain and/or affect body mechanics, leading to other joint problems.
• Presses on a nerve, leading to neuropathy. Neuropathy can cause many sensations, most typically numbness, tingling, burning, or shooting pain.

Treatment will also be recommended if a nodule breaks through the skin, causing a lesion that may not heal well on its own or become infected. Medical treatment may include a steroid injection into the nodule and/or a change in medications. Occasionally, surgery to remove the nodule is recommended.

Read more about Cortisone Injections (Steroid Injections)

There Are Visible Changes to Joints

RA can cause a joint’s cartilage and bones to erode over time. In addition, ligaments may stretch or weaken, and tendons may become damaged or inflamed. These changes can cause a visible deformity that affects a joint’s appearance and function.

Most joint deformities affect the small joints of the hands or feet. For example, ulnar deviation occurs when the large knuckles (MCP joints) are so damaged that the fingers begin to dislocate and drift sideways, away from the thumb and toward the ulna bone in the forearm.

See Hand Rheumatoid Arthritis Signs and Symptoms and Foot and Ankle Rheumatoid Arthritis (RA) Symptoms

While some deformities are permanent, others may be treated or even reversed. Joint deformities are less common than they used to be thanks to better treatment options.

Joints Feel Worse, Even with Treatment

Rheumatoid arthritis disease activity causes inflammation that triggers pain, stiffness, swelling, and decreased joint function. Joints that do not get better with treatment are a sign that medications should be changed. Over time, a failure to effectively reduce RA inflammation can lead to permanent joint changes and is also associated with other problems, such as heart disease.

Keep in mind that RA medications often take weeks, even months, to be fully effective. Sometimes symptoms may worsen before a new drug has had time to work.

See 5 Types of Medication That Treat Rheumatoid Arthritis (RA)

A physician can help determine if the worsening symptoms are a cause for concern and if the treatment plan needs to be adjusted. Occasionally, symptoms that get worse and do not respond to medication may prompt a re-evaluation of the diagnosis.

See Rheumatologist's Role in Patient Care

Numbness or Tingling in the Hands or Feet

A nerve that is damaged or pinched can cause numbness or tingling. The most common ways rheumatoid arthritis causes damaged or pinched nerves include inflammatory joint swelling and rheumatoid vasculitis.²Agarwal V, Singh R, Wiclaf, et al. A clinical, electrophysiological, and pathological study of neuropathy in rheumatoid arthritis. Clin Rheumatol. 2008;27(7):841-844. doi:10.1007/s10067-007-0804-x PMID: 18084807

• Inflammation and swelling caused by RA may put pressure on a nerve. For example, swelling in the wrist can put pressure on the median nerve, causing carpal tunnel syndrome and leading to weakness, numbness, and/or tingling in the thumb, index, and middle fingers.
• Vasculitis,³Upreti S, Oudah M, Hauptman H, Minn H. Vasculitic neuropathy associated with Rheumatoid Arthritis, a case report. J Community Hosp Intern Med Perspect. 2019;9(5):430-432. Published 2019 Nov 1. doi:10.1080/20009666.2019.1676507 PMID: 31723390^,4Puéchal X, Said G, Hilliquin P, et al. Peripheral neuropathy with necrotizing vasculitis in rheumatoid arthritis. A clinicopathologic and prognostic study of thirty-two patients. Arthritis Rheum. 1995;38(11):1618-1629. doi:10.1002/art.1780381114 PMID: 7488283 or inflammation of blood vessels, may reduce blood flow to the feet or another part of the body. The decreased blood flow can cause tingling, numbness, and other symptoms, such as muscle weakness.

Tingling and numbness are symptoms that must not be ignored. Early treatment is the best way to reduce these symptoms and prevent them from getting worse or becoming chronic.

People with RA may have other signs and symptoms that are not directly caused by RA. Instead, these signs and symptoms are related to medical conditions that are associated with RA, ranging from heart problems and chronic kidney disease to Sjogren’s syndrome and skin infections.

Read more about 9 Unusual Symptoms Linked to Rheumatoid Arthritis