Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. This inflammation can lead to pain, swelling, stiffness, and loss of function in the joints. Many people with RA experience pain on a daily basis, but the severity and duration of the pain can vary. Some key things to know about rheumatoid arthritis pain:
RA pain may be more severe in the mornings
Many people with RA experience more intense joint pain and stiffness when they first wake up in the morning or after long periods of inactivity. This is known as “morning stiffness” and it can last for an hour or more after waking. The joints may feel warm and tender during this time as well. Morning stiffness results from the inflammation in the joints becoming more prominent after long periods of immobility during the night. Moving and activity can help relieve the stiffness.
Pain may fluctuate throughout the day
For many people with RA, the pain and stiffness tend to ease up throughout the day and after moving around. However, some people do continue to experience moderate to severe joint pain throughout the day that limits their mobility and ability to perform daily tasks. Flare-ups of increased disease activity can also lead to worsening of pain.
Pain is often felt in multiple joints
RA usually affects joints bilaterally, meaning it impacts the same joints on both sides of the body. Common areas include the small joints of the hands and feet, wrists, knees, ankles, elbows, hips, and shoulders. Multiple affected joints mean multiple sources of pain. The pain may shift locations or radiate from one area to another.
Pain severity varies from person to person
The degree of joint pain experienced by people with RA covers a wide spectrum. Some people have relatively mild pain that they are able to manage well with rest, heat/cold therapy, bracing, and medication. For others, the pain can be moderate to severe on a daily basis and significantly limit physical function. Severe RA pain may be described as a constant, dull ache or a sharp, shooting, or burning sensation in the joints.
Flares can make pain worse
RA fluctuates between periods of low disease activity (remission) and flares of increased inflammation and symptoms. During flares, people often experience a dramatic worsening of pain, swelling, and stiffness in multiple joints that may last for days or weeks. Flares can occur unpredictably and be very frustrating and disabling for those with RA.
Pain is a sign of inflammation
The pain of RA reflects inflammation within the joint structures, including the synovial membrane, cartilage, and bones. Inflammatory chemicals and immune system cells flood the joint and cause swelling, warmth, redness, and damage to the tissues. This leads to the pain signals. That is why reducing inflammation is a prime target of RA treatments.
What causes the pain of rheumatoid arthritis?
The pain associated with rheumatoid arthritis stems from several sources involving the complex inflammatory processes in the joints:
Synovial inflammation
The synovial membrane that lines the joint becomes inflamed and thickened. It produces excess joint fluid and inflammatory chemicals like cytokines that irritate nerve endings and stimulate pain receptors.
Cartilage and bone damage
The cartilage and bones become eroded from the enzymes and cytokines released by the synovium. As the protective cartilage wears down, the bones rub together causing pain.
Tendon and ligament friction
Inflamed tendons and ligaments around the joint become irritated as they move and rub against bones and other joint structures.
Muscle spasms and cramps
Muscles around the joints may spasm and cramp in response to inflammation and joint instability, leading to additional pain.
Nerve compression or entrapment
Nerves around the inflamed joints can become compressed or entrapped, resulting in numbness, tingling, and radiating pain through the limbs.
Joint instability and deformity
Damaged joints are less stable and misaligned. Abnormal motions cause pain with movement. Joint deformities from RA changes also contribute to discomfort.
Fatigue
The chronic widespread inflammation of RA causes fatigue and feelings of weakness, making the pain feel more intense and joints harder to move.
What are the common times of day people with RA experience the most pain?
Morning
Morning joint stiffness and pain after waking are hallmarks of RA for many patients. The prolonged inactivity of the joints at night allows inflammation to build up and stiffen the joints.
Late afternoon
Pain may worsen in the late afternoon as the effects of any morning medications wear off and fatigue accumulates during the day.
Evening
By the evening after a full day of activity and demands on the joints, pain often ramps up along with inflammation, especially if an RA flare is occurring.
Night
Pain can disrupt sleep and cause difficulty getting comfortable. Staying in one position can also lead to worsening stiffness and pain.
During weather changes
Many with RA report increases in daily joint pain before rain or with changes in barometric pressure and humidity. Colder temperatures can also make pain worse.
How is rheumatoid arthritis pain described?
People use various terms to describe the type of pain caused by rheumatoid arthritis:
Aching
A constant, dull, throbbing pain. Usually the most common way RA pain manifests, as opposed to short, sharp pains.
Stabbing
Brief but intense piercing pain, like being stabbed with a knife. Can be very severe when it occurs.
Burning
A hot, searing pain like a body part is on fire. May be due to severe inflammation.
Shooting
Sudden sharp pains that shoot through the affected joint and may radiate down the limb. Caused by irritated nerves.
Stiffness
Difficulty moving the joint through its normal range of motion accompanied by pain. Worsened by prolonged inactivity.
Throbbing
Rhythmic pulses of pain synced with the heartbeat. Can prevent falling asleep at night.
Soreness
Deep muscle-like ache that intensifies with movement or pressure on the joint. Indicates inflammation.
Tenderness
Exquisite sensitivity to touch around the joint. Even light pressure may trigger pain.
Tightness
Feeling like the soft tissues around the joint have shrunk and resistance or stretching is felt when moving.
What makes rheumatoid arthritis pain worse?
Certain triggers and activities typically exacerbate the pain of rheumatoid arthritis:
Using the affected joints
Increased physical activity involving the inflamed joints worsens pain later that day or the next morning.
Repeated motions
Doing the same movement over and over stresses the damaged joints and causes more pain.
Lifting and gripping
Activities that require strength and stable joints, like lifting objects, turn faucet handles, or opening jars, increases pain.
Morning stiffness
Pain is often more intense in the morning until the joints are moved around to loosen up.
Bad weather
Cold, damp, windy weather can make RA pain flare up throughout the day.
Bumps, knocks, and falls
Any impact or jostling of the inflamed joints increases pain. Falls are especially painful.
Twisting motions
Quickly twisting or rotating joints that are already unstable is likely to result in a pain spike.
Fatigue and stress
Exhaustion reduces tolerance for pain. Emotional stress releases hormones that amplify pain signals.
Immobility and cramped positions
Sitting still or being in one position too long makes pain worse until movement or stretching occurs.
What makes rheumatoid arthritis pain better?
Certain remedies, treatments, and lifestyle measures can help reduce rheumatoid arthritis pain:
Heat packs
Applying heat pads or taking warm baths alleviates joint stiffness and aching pain temporarily. Improves circulation.
Cold therapy
Icing the joints reduces acute swelling that may be causing pain. Especially helpful after activity.
Medications
Prescription anti-inflammatory drugs, steroids, biologics, and DMARDs ease systemic inflammation and calm RA pain over time.
Exercise
Light physical activity gets synovial fluid moving to lubricate the joints and releases natural pain relievers.
Massage
Gentle kneading around the joints loosens muscles, boosts circulation, and distracts the nerves from pain signals.
Assistive devices
Canes, walkers, splints, or braces provide extra support to unstable joints and take pressure off sources of pain.
Stretching
Slow gentle stretching increases flexibility and range of motion in the tissues surrounding painful joints.
Rest
Taking breaks to briefly rest painful joints allows inflammation to subside and prevents overexertion.
Distraction
Shifting attention away from the pain centers using relaxation techniques, hobbies, or social interaction helps lower pain perception.
How is rheumatoid arthritis pain managed on a daily basis?
People living with RA pain incorporate a variety of self-care strategies into their daily routine:
Take all prescribed medications consistently
DMARDs, biologics, and other RA drugs work best when taken per instructions every day to control inflammation.
Try over-the-counter anti-inflammatories
NSAIDs like ibuprofen or naproxen sodium can supplement prescription meds for pain relief.
Start the day slowly
Take time to gently stretch and allow joints to loosen up in the morning before physical activities.
Apply heat or cold therapy
Use heating pads, compresses, paraffin wax, etc. to ease stiffness and pain as needed.
Pace activities through the day
Alternate periods of activity with breaks to avoid overstressing painful joints.
Use joint protection techniques
Avoid motions that strain joints like extensive gripping, bending wrists, crossing legs, etc.
Utilize assistive devices
Braces, canes, jar openers reduce the need to overuse tender joints.
Exercise moderately
Do a manageable level of flexibility and cardio exercise to strengthen muscles around joints.
Listen to your body
Adjust activities as needed when pain signals joints need rest. Don’t push through intense pain.
Make time for relaxation
Use stress-reduction techniques like meditation to lower tension, fatigue and pain sensitivity.
When should someone see a doctor for rheumatoid arthritis pain?
People with RA should consult their rheumatologist right away if they experience:
- Sudden, severe joint pain that is much worse than normal
- Multiple swollen, hot joints with extreme tenderness
- Joint pain combined with a fever, rash, or other illness symptoms
- Significant worsening of pain and stiffness, especially in the mornings
- New pain in previously unaffected joints
- Pain, numbness, or tingling that radiates down an arm or leg
- Inability to move or bear weight on a joint
- Deformity or change in shape of joints
- Pain that is not responding to usual medical treatments
- Frequent falls or injury due to unstable, painful joints
- General sense of feeling unwell and loss of appetite
These types of symptoms may indicate a disease flare, new RA damage, infection, or other complications requiring swift medical care. Ongoing severe pain can also take a major toll on daily function and quality of life, so additional pain management options should be explored.
Conclusion
Rheumatoid arthritis is a complex, progressive disease that almost always involves some degree of chronic inflammatory pain on a daily basis. While RA pain is very common, its specific characteristics and severity vary widely between individuals based on the joints involved, types of tissue damage, disease activity, and pain threshold.
The pain may come and go but is typically worse in the mornings, during weather changes, with repetitive use of joints, and when disease flares occur. Finding the right combination of lifestyle adaptations, assistive devices, anti-inflammatory medication, and pacing of physical demands is essential to keeping the daily pain as manageable as possible. Ongoing communication with your rheumatology team ensures the best pain-control strategy for your individual situation.
