When Does Rheumatoid Arthritis Start?

Rheumatoid arthritis (also often called ‘RA’) is a long lasting, chronic inflammatory disease in which the body immune system goes awry and causes swelling (inflammation) in many parts of the body. Though it primarily affects the joints, it can also affect non-joint structures. When and how it starts may vary from patient to patient. But it usually develops gradually!

Rheumatoid arthritis is an autoimmune disease

The body immune system, as the name suggests, is responsible to protect the body from any antigens (invaders) such as germs and infectious organisms. It is a complex system made up of special cells, tissues, proteins and organs to defend your body against disease. But sometimes, it goes awry and leads to illness. For such case, it is called ‘autoimmune disease’.

Your immune system doesn’t work as well as usual if you have autoimmune disease. It can mistakenly attack the wrong targets, healthy tissues of your body for example. As a result, this abnormality can lead to a number of serious problems.

The exact answer of how the body immune system malfunctions in this way is not clear yet, though there are some theories. Some experts believe that the disease may be associated with virus /bacteria, certain medication, or chemical /environmental irritants. Also, it seems that this abnormality runs in family – your risk of developing the disease might increase if you have a family history of the same condition.

There are a number of different types of autoimmune diseases. Rheumatoid arthritis is one of the most common ones.

The effect of autoimmune disease can be systemic. Systemic means it affects many different types of body tissue /organ, depending on the type.

Here are some of other autoimmune disorders:

  1. Systemic lupus erythematosus, an autoimmune condition that affects many parts of the body including the joints, skin, brain, kidney, or other organs.
  2. Psoriasis, a systemic skin condition that is typically characterized by irritation and redness – as well as flaky, thick, white-silver patches on the affected skin.
  3. IBD (inflammatory bowel disease), a group of inflammatory conditions affecting the colon and small intestine.
  4. Vitiligo, a skin disorder whereby the skin loses the pigment.
  5. Thyroid disorders, especially such as Hashimoto’s disease (a disorder in which the thyroid gland gets inflamed and swollen) and overactive thyroid gland called Grave’s disease.
  6. Type-1 diabetes, a rare type of diabetes associated with the abnormality of immune system that destroys the insulin producing cells of pancreas.
  7. Sjögren’s syndrome – a disorder in which the production of saliva in the mouth and eyes is affected, causing dry eyes and mouth.
  8. Addison’s disease, a disorder that causes low level (lower than normal) of adrenal hormone.
  9. Other types of arthritis, such as psoriatic arthritis and reactive arthritis.

Many of these autoimmune disorders (including RA) have similar symptoms, making them more difficult to diagnose! However, common symptoms include fever, lethargy, and feeling ill (general malaise). And typically, the symptoms get worse during flare-ups and settle down during remission. In other words, autoimmune disease usually fluctuates between periods of flare-ups and remission.

The bad news, there is a chance to have more than one autoimmune disorder at the same time. For example, sometimes RA can coexist with lupus or another autoimmune disorder. Sjögren’s syndrome is also quite common in people with RA, see more in here!

There is still no curative therapy for autoimmune disease. But some treatments are available to cope with. The goal of the treatment is usually aimed to relieve the symptoms (particularly during flare-ups) and make the disease go into remission.

When does rheumatoid arthritis start?

Based on how the disease progresses, we have some of the following categories:

  1. Monocyclic, a condition of when the symptoms occur and then go into remission for long periods of time. For example, they may not appear again for 2-5 years.
  2. Polycyclic, when there is a fluctuated period of the symptoms. The symptoms come and go, worsening and improving over the course of the condition.
  3. The disease gets worse over a period of time.

People with RA may have more than one type of those categories. But in general, the disease is a progressive condition. Therefore early treatment is important to control the disease more easily. When it has become advanced, if it has caused its complications for example, it is more difficult to treat.

RA starts to occur when the abnormality of your body immune system targets the lining of your joints. This is especially true when the malfunction attacks the lining of membranes surrounding the joints called ‘synovium’!

The affected synovium can get inflamed (swollen) and thickened, which then will eventually cause serious damage to other parts of the joint such as the bone and cartilage. The tendons and ligaments can also weaken and stretch. Over time, the affected joint can lose its normal structure, including its shape and alignment.

Early stage of the disease is more likely to attack your smaller joint first (such as joints that attach between toes and feet – or fingers and hands). As your RA progresses, it may then affect your larger joints.

And again, if it has become advanced, it can be systemic. For instance, advanced RA can also affect non-joint structures of the body (such as skin, lungs, blood vessels, heart, eyes, kidneys, bone marrow, and more).

While early treatment is important to help control the disease and prevent the complications, but it’s not always easy to catch RA early! Though most cases are diagnosed in middle age, some people may experience early symptoms long before this time!

See a doctor promptly if you notice the following symptoms. These may be early signs of the disease:

  1. Swollen in one /more smaller joints such as finger-knuckle joints.
  2. Swollen /tenderness in knee, shoulder, elbow, or ankle that last longer than usual, more than 6 weeks for example.
  3. Flu-like symptoms (including fatigue and fever) that are difficult to relieve. They may come and go.
  4. You have joint stiffness, typically in the morning. Morning joint stiffness associated with RA can last longer (more than an hour) than osteoarthritis, the most common type of arthritis. See also the complete list of differences between RA and osteoarthritis in this section!
  5. Tender, small bumps under the skin – especially just under the skin of the elbow.

Even in some cases, early symptoms may appear as early as age 18 (RA can occur at any age, though again it mostly begins in middle age). There are a number of reasons to make these symptoms go unnoticed, these may include:

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