Often the first thing that people notice is pain in and around the joints. However, pain is a very non-specific finding, and many conditions may lead to pain without an underlying arthritis.
For many types of inflammatory arthritis, so-called ‘constitutional symptoms’ are very common – fatigue, lethargy, ‘flu-like symptoms, loss of appetite and weight loss may occur. Not uncommonly, these symptoms may develop weeks or even months before any joint pain becomes apparent. This can make it very difficult to come to a diagnosis in the early stages of a disease.
The hallmark of inflammation in the joints is swelling. Joints may become swollen individually or in groups, and symptoms may move around over time, settling on one or two joints for a few days, before moving to different areas. Often, swollen joints become warm, red, and tender, but this is not always the case. If joints become swollen, particularly the joints of the hands and feet, then medical assistance should be sought, as this might indicate the development of arthritis. It is important for a GP to see the joints to look for swelling, and consider referral on to a Rheumatologist.
Joints that are affected by arthritis are often stiff. In the case of inflammatory conditions, the stiffness is usually most profound after periods of inactivity – especially first thing in the morning (so-called ‘early morning stiffness’). This may gradually improve with exercise, but can take several hours.
Cold hands (Raynaud’s)
Some people with arthritis suffer with cold hands and feet. The fingers and toes in particular may become cold and change colour – often going white, then blue, and then red on warming. This is called ‘Raynaud’s phenomenon’ after the French physician who first described the condition, and is due to changes in the calibre of the blood vessels.
Some types of arthritis are associated with rashes. The most common is psoriasis / psoriatic arthritis, but other, rarer conditions such as systemic lupus erythematosis (lupus / SLE) may also cause rashes. Sometimes these may occur in response to sunlight (‘photosensitivity’).