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How long can you have rheumatoid arthritis and not know it?

Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation and pain in the joints. In some cases, RA can develop gradually over time without any obvious symptoms at first. This means it’s possible to have rheumatoid arthritis for months or even years before receiving a diagnosis.

What are the early signs and symptoms of rheumatoid arthritis?

The most common early signs and symptoms of rheumatoid arthritis include:

  • Joint stiffness, especially in the morning or after periods of inactivity
  • Pain or aching in the joints, often affecting both sides of the body equally (symmetrically)
  • Fatigue and lack of energy
  • Low-grade fever
  • Muscle aches
  • Difficulty sleeping

In the beginning, RA symptoms may be intermittent and come and go. They often affect the smaller joints first, especially those in the hands and feet. As the disease progresses, symptoms tend to become more persistent and spread to other joints like the wrists, knees, ankles, elbows, hips, and shoulders.

Why do the early symptoms go unnoticed?

There are a few reasons why someone might not recognize the early symptoms of rheumatoid arthritis:

  • The symptoms can be mild and vague at first. Joint stiffness and achiness could be brushed off as signs of overexertion or aging.
  • Symptoms may come and go, giving the impression that it’s not a chronic problem.
  • Younger people often don’t suspect rheumatoid arthritis since it’s thought of as an “old person’s disease.”
  • People lack awareness of the typical RA symptoms.
  • Early symptoms may not disrupt daily activities enough for someone to seek medical care right away.

Additionally, rheumatoid arthritis symptoms overlap significantly with other common conditions like osteoarthritis, fibromyalgia, chronic fatigue syndrome, and thyroid problems. It’s not uncommon for someone to attribute their joint pain and fatigue to one of these other diagnoses initially.

How long can you have rheumatoid arthritis without knowing?

There is no definitive timeline for how long someone can have undiagnosed rheumatoid arthritis. Some sources suggest it takes an average of 6 to 12 months from the onset of RA symptoms for an individual to receive a diagnosis. However, this timeframe can vary substantially.

In one study, it took participants an average of 11 months to get diagnosed with rheumatoid arthritis from the time they first noticed symptoms. But this ranged widely from 2 months up to 10 years.

Certain factors can contribute to a delayed rheumatoid arthritis diagnosis:

  • Younger age at onset
  • Milder symptoms at first
  • Symptoms present in less than 5 joints
  • Negative rheumatoid factor blood test
  • Absence of joint damage on x-rays

Overall, the course of early, undiagnosed RA is variable. Some people develop symptoms that come and go over a period of months to years. For others, the symptoms are steadier and more rapidly progressive. But it’s certainly possible to live with untreated rheumatoid arthritis for several years before getting a definitive diagnosis.

When should you see a doctor for joint pain and inflammation?

It’s recommended to see a doctor promptly if you experience any of the following:

  • Joint pain, swelling, or stiffness that doesn’t improve with rest or over-the-counter medications
  • Morning joint stiffness that lasts over 30 minutes
  • Multiple joints are affected, especially on both sides of the body
  • The wrists, metacarpophalangeal (MCP) joints of the hands, proximal interphalangeal (PIP) joints of the hands, and/or the knee joints are affected
  • You have other unexplained symptoms like fatigue, muscle aches, low fever, or weight loss along with joint problems

While there are many possible causes of joint inflammation and pain to consider, persistent or worsening symptoms warrant medical evaluation for a proper diagnosis. Early treatment can help slow the progression of joint damage that occurs with rheumatoid arthritis.

What tests confirm a rheumatoid arthritis diagnosis?

There is no single test that definitively diagnoses rheumatoid arthritis. Doctors use a combination of factors to make a diagnosis:

  • Medical history: Details about symptom onset, joint involvement, timing, relieving/exacerbating factors, family history of autoimmune disease, etc.
  • Physical exam: Looking for swelling, warmth, and tenderness in multiple joints. Examining for swelling and nodules in other tissues.
  • Imaging tests: X-rays and MRI scans to visualize damage and inflammation in the joints. May be done at multiple time points to assess changes.
  • Lab tests: Blood tests look for inflammatory markers (ESR, CRP), rheumatoid factor, and anti-CCP antibodies. These are present in many RA patients.

Your doctor will analyze all of these factors together since no single test can definitively diagnose RA in every case. The diagnosis may become more apparent as symptoms progress over time.

What is the outcome if rheumatoid arthritis goes undiagnosed and untreated?

Leaving rheumatoid arthritis undiagnosed and untreated for a prolonged time can allow permanent joint damage to occur. The inflammatory chemicals released in untreated RA break down cartilage, bone, and the surrounding joint tissues.

Over time, uncontrolled inflammation can cause:

  • Joint deformity and malalignment
  • Severely limited range of motion
  • Loose or unstable joints
  • Tendon rupture
  • Joint fusion
  • Chronic pain

This joint destruction is irreversible. But medications can help slow or stop further damage if RA is caught and treated early enough. Disability is more likely when diagnosis and treatment are delayed for many years.

There are also risks beyond the joints if RA goes untreated. Chronic inflammation can increase cardiovascular disease risk. And certain RA medications used to suppress the immune system also raise the chances of serious infections.

Starting treatment promptly is key

The good news is that modern rheumatoid arthritis treatments can help put the disease in remission and preserve joint function when started early. This makes prompt diagnosis critical.

Be alert for any unexplained joint symptoms, especially in multiple joints or on both sides of the body. See a doctor right away if you notice signs of possible RA so appropriate testing and treatment can begin as soon as possible.

While it may take months or longer for symptoms to point to rheumatoid arthritis, getting a prompt workup and accurate diagnosis allows treatment to begin right away. This gives you the best chance of living well with RA before severe joint damage can occur.

The takeaway

  • Rheumatoid arthritis symptoms like joint pain and stiffness can come and go subtly in the beginning stages, sometimes causing people to overlook the problem for months or years.
  • On average, it takes 6 to 12 months from onset of symptoms for someone to get diagnosed with RA. But the timeline varies widely.
  • Younger patients with mild symptoms in fewer than 5 joints often have the longest lag time before diagnosis.
  • Leaving rheumatoid arthritis undiagnosed for too long allows irreversible joint damage to occur.
  • Early treatment is critical to prevent disability – see a doctor promptly if you have persistent or worsening joint symptoms.