Learning about these symptoms can help you get the right diagnosis

By Greg Freeman

As a disease, arthritis is more complicated and varied than most people imagine. It can come in different forms and affect people in different ways. But the common thread through most forms of arthritis? Inflammation and stiffness of the joints.

Swelling may occur for two key reasons. Either the lining of the joint, known as the synovium, swells (synovitis) or the synovial fluid increases in volume (an effusion). It is an active process: inflammatory cells (mainly white cells) and more blood enter the joint, while many inflammatory molecules, such as small proteins (peptides) are released into the soft tissues around the joint. The increased blood flow makes the joint swell and feel warm. The inflammatory materials cause joint fluid to collect in and around the joint, which adds to the swelling. The type of joint swelling can vary depending on the type of arthritis you have.

Inflamed joints can feel especially stiff first thing in the morning. How long it lasts is important: an hour or more is suggestive of inflammatory arthritis. Defining morning stiffness is hard, although people with arthritis describe it as an ache combined with difficulty moving. Stiffness following exercise is usually a feature of osteoarthritis; it is a sign that the joints are starting to fail. People also feel stiff when they rest, such as sitting down after a walk or relaxing in the evening. The joints are sometimes said to “gel,” a term reminiscent of how gelatin sets — a gradual process of firming up. Joint stiffness may occur with or without joint pain. Stiffness can affect any joint– the fingers and hands, wrists, elbows, knees, ankles, feet, shoulders, hips, and even the jaw.

KNOW YOUR SYMPTOMS

Other signs and symptoms in addition to the inflammation and stiffness will help your doctor figure out what kind of arthritis you have.

In RA, the immune system attacks the lining of the joint becomes inflamed, leading to the stiffness, pain, warmth, redness, and swelling around the joint. Then the disease leads to rapid division and growth of cells, which causes the synovium to thicken. Later the inflamed cells release enzymes that may digest bone and cartilage, causing joint erosion. The swelling, warmth and stiffness that accompany RA can last for hours. It can affect any joint, but usually starts in small joints (like those in the hands or feet) and occurs on both sides of the body. Joint stiffness is usually worst in the morning. Other symptoms such as pain or fatigue tend to develop and worsen over several weeks or months.

OA usually occurs due to wear and tear, injury or both. The most commonly affected joints are the lower back, hips, knees and feet. Although inflammation is not a main symptom of osteoarthritis, it can occur in the joint lining in response to the cartilage breakdown. Morning stiffness may be severe but is usually brief – less than 30 minutes, that occurs after waking up in the morning or a period of rest. Joint redness, warmth and swelling are usually minimal.

In psoriatic arthritis, joint pain is usually associated with swelling and redness in the knees, ankles, fingers, and toes. Some people with psoriatic arthritis also have neck and/or back pain, along with stiffness that can limit movement. The disease can also include swelling of fingers and/or toes that gives them a “sausage-like” appearance. Silver or gray dry, scaly spots on the scalp, elbows, knees and/or the lower end of the backbone with flaking skin can be associated with PA, as can small depressions in the fingernails and/or toenails, and/or detachment of nails.

In an arthritis-related disease called systemic lupus erythematous (SLE, or commonly called lupus), the immune system attacks itself causing swelling and pain. Most individuals with lupus have rashes, swollen joints, fever and feel fatigued. Sometimes weight loss and hair loss in spots or around the hairline occurs.

© 2014 Arthritis Foundation. All Rights Reserved.