6 Causes of Rheumatoid Arthritis Pain Aside from Inflammation (2022)

Tracking your RA pain canhelp you better understand your conditionand talk about it with your doctor. Join ArthritisPower, a patient-centered research registry, to learn more about your RA. Sign up here.

Inflammation is the root cause of rheumatoid arthritis (RA) pain — but it’s certainly not the only cause. In fact, many people with RA experience joint pain without swelling and other types of pain, in spite of having low levels of inflammation, few affected joints, and low disease activity.

Rheumatoid arthritis is a chronic, inflammatory autoimmune disorder in which the body’s own immune system attacks the lining of the membranes that surround the joints (the synovium). It often causes pain, stiffness, and swelling of multiple joints on both sides of the body.

However, it is possible to have RA and experience pain for other reasons at the same time.

“If a rheumatologist and RA patient have a mutual understanding that the rheumatoid arthritis is in remission, then we need to explore why the patient is still having pain,” says Elizabeth Schulman, MD, a rheumatologist at Hospital for Special Surgery in New York City.

Although figuring out the root cause of pain can feel like a guessing game — if it’s not RA, what else could it be? — there are several other common conditions that should be considered.

“Other issues can cause pain in people with RA beside rheumatoid arthritis, which is important to remember,” says rheumatologistAngus Worthing, MD, a clinical assistant professor of medicine at Georgetown University Medical Center in Washington, D.C. “Broken bones, torn or sprained muscles or tendons, carpal tunnel syndrome, sudden muscle strain in the low back or neck, tendinitis, and bursitis — they all happen to people with RA, but might not be caused by RA.”

Lack of sleep (sometimes referred to as painsomnia) and depression can also certainly be part of the pain equation. It’s a vicious cycle, says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida. “Pain creates insomnia, which leads to more pain, which contributes to depression, which then affects pain,” he says.

Here is a look at some common co-occurring conditions that you may mistake for RA pain, along with what you can expect if RA isn’t the only medical issue you’re trying to treat.

Osteoarthritis (OA)

Osteoarthritis is a condition in which the cartilage that cushions a joint wears away, causing pain and stiffness. It typically occurs later in life (usually after age 50) though it may start earlier, especially if your joints have become damaged by rheumatoid arthritis or injury. This is called secondary OA, notes Leah Alon (Nichols), MD, a rheumatologist in New York City. Secondary osteoarthritis can also occur after a joint injury.

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The risk of someone with RA developing primary OA, which occurs with age and joint use but has no underlying causes, is the same as the general population. Primary OA occurs in joints unaffected by inflammatory arthritis.

OA is characterized by abnormalities in all of the tissues in the joint, leading to symptoms and loss of normal joint function. “OA sometimes affects different joints than RA, including the base of thumb, one or the other knee or hip, the big toe, and DIPs of hands,” says Dr. Worthing.

The distal interphalangeal joint (DIP) joint is located at the tip of the finger, just before the nail starts.

“OA is generally stiff for less than 30 minutes in the morning, and may lead to only bony but not soft swelling,” Dr. Worthing continues. “OA classically causes ‘gel’ phenomenon in which a joint may feel stiff, sore, or aching for a short time after rest, like when you have to ‘walk off’ knee pain after prolonged sitting or standing.”

By contrast, RA usually affects the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, is symmetric, and causes more prominent morning stiffness and pain, he adds. The MCP joint is where the hand bone (the metacarpal) meets the finger bones (the phalanges). The PIP joint (PIP joint) is located between the first two bones of the finger (near where your knuckles are).

If your rheumatologist suspects you could have OA, a physical exam and X-ray can be used to diagnose OA. “It’s important to diagnose OA because it helps distinguish when OA is causing joint pain instead of RA,” says Dr. Worthing.

How This Affects Treatment

In this case, RA medication won’t need to be escalated, and OA pain can be treated with pain relief measures, Dr. Worthing says.

Treatment for OA includes non-steroidal anti-inflammatory drugs (NSAIDs)and acetaminophen (Tylenol) to control pain and inflammation, as well assteroid injections in an affected joint.


Fibromyalgia, a chronic pain condition characterized by fatigue and pain all over the body, is common in people with rheumatoid arthritis, says Dr. Schulman. In fact, a 2019 study published in the journal Best Practice & Research Clinical Rheumatology cites that between 18 percent and 24 percent of people with RA also have fibromyalgia.

This might be due to changes in the way the nervous system perceives and processes pain in people with RA, which can trigger fibromyalgia.

While someone with RA can often point to a specific body part (like the hand) that has swelling, redness, and stiffness in addition to pain, someone with fibromyalgia tends to experience widespread pain and tenderness at soft tissues, and pain in multiple organ systems (headaches, abdominal pain, sinus, or urinary tract pain), explains Dr. Worthing. Unlike RA, there is no swelling in the joints with fibromyalgia.

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Many patients describe fibromyalgia pain as “catastrophic,” he adds, and some may experience tingling or burning sensations in areas of the body as well as significant fatigue, disturbed sleep, difficulty concentrating or remembering things (fibro fog), and depression. Fibromyalgia could make you overly sensitive to temperature and touch.

Fibromyalgia is a challenging disorder to diagnose because there’s no single test (such as a blood test or an imaging test like an X-ray) that can confirm a diagnosis. Rather, fibromyalgia is considered a “diagnosis of exclusion,” which means doctorsneed to first rule out other health problems.

If your rheumatologist suspects fibromyalgia, they will listen to your history and symptoms, including their severity and duration, and may do a physical exam to check for painful areas and tender points.

How This Affects Treatment

“Fibromyalgia can be treated with graded gentle exercise, adequate sleep, medications that affect pain neurotransmitters, such as muscle relaxants, antidepressants, and drugs that are or are similar to antiseizure drugs, and cognitive behavioral therapy,” says Dr. Worthing.

Carpal Tunnel Syndrome

Carpal tunnel syndrome(CTS) occurs when a major nerve in the hand — the median nerve — becomes compressed in the carpal tunnel, a narrow passageway on the palm side of your wrist that also houses the tendons that bend the fingers.

“If your wrist joint swells with RA, it’s a very narrow canal there, and the swelling can press the nerve and you get carpal tunnel syndrome,” says Dr. Alon. “You have to treat the swelling from the RA to make that type of carpal tunnel better.”

In addition to RA, a number of health problems can also cause swelling of this area, including diabetes, thyroid issues, and hormonal changes that occur during pregnancy. Injuries, such as a wrist fracture, can also contribute to the onset of carpal tunnel syndrome.

Both RA and CTS affect the hands and wrists, but RA usually affects other areas of the upper and lower body in addition to the wrist area, says Dr. Worthing. RA is also usually present in both hands, while CTS can occur in only one, typically a person’s dominant hand.

“CTS causes numbness, tingling, and pain that can shoot down to the fingertips,” says Dr. Worthing. “RA causes pain that is aching, stiff, or sore.” Pain from CTS may also be worse at night, and unlike RA, there is no swelling.

To diagnose CTS, your rheumatologist will perform a physical exam of the wrist joint (tapping the inside of your wrist, or asking you to bend your wrist down for minute), and do an ultrasound testing of the nerve, or EMG (electromyography), which measures electrical activity of the nerve.

How This Affects Treatment

“If RA is causing the CTS, RA therapy can be escalated or a cortisone injection can be given,” says Dr. Worthing. If CTS exists unrelated to RA, it is often treated with physical therapy, splinting, pain medication, cortisone injection, or surgery in less common cases.

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Back Pain

Some people with RA report experiencing back pain, but if lower back pain is your primary pain symptom, it’s likely not due to RA.

“Sometimes patients say that parts of their spine hurt,” says Dr. Alon. “RA can affect the cervical spine [the neck area] but it does not affect the lower spine.”

This is because your lower back does not have synovium, the thin membrane that lines your joints, which gets inflamed with RA.

“Chronic low back pain is virtually impossible from rheumatoid arthritis,” says Dr. Domingues. “The only joint in the back with synovium is the atlanto-occipital joint,” which is located between the base of the skull and the cervical spine.

RA may indirectly affect the back because it increases a person’s risk of developing osteoarthritis and osteoporosis, which can both result in back pain. In most cases, however, low back pain is likely mechanical pain — triggered by the movements of the body, says Dr. Worthing.

If your back has been bothering you, consider your recent activities before chalking up your pain to RA. Did you overdo it at the gym? Did you lift something heavy? Have you been painting your home? Communicating these types of activities known to cause back pain can help your rheumatologist make a diagnosis and recommend treatment.

How It Affects Treatment

The best way to treat mechanical back pain is to allow time to let things heal, try physical therapy, and use pain relief measures like NSAIDs or heat or ice therapy. Lifestyle changes, including losing weight, quitting smoking, improving posture, and exercising more, as well as steroid injections may also be recommended. Surgery is considered a last resort.


Bursitis is a painful condition that occurs when small, fluid-filled sacs — called bursae — that cushion the bones, tendons, and muscles near your joints become inflamed.

“Bursitis is caused by inflammation, but it’s not inflammation in the joints,” says Dr. Domingues. “It’s inflammation in the adjacent tissue called bursa.” Having RA slightly raises your risk of having bursitis, he notes.

Bursitis commonly affects the shoulder, elbow, hip, and knee, and is often caused by repetitive motions or positions that put pressure on the bursae around a joint. “You’ll feel pain when you walk or use your shoulder,” explains Dr. Domingues.

(Video) Rheumatoid Arthritis (RA) Signs & Symptoms (& Associated Complications)

Although RA tends to be a small-joint disease, it can spread to both of your hips as the disease progresses. Inflammatory arthritis in your hip will feel painful and stiff, be worse in the morning, and gradually improve with activity. Hip joint issues may also manifest as groin pain.

“True hip pain from trochanteric bursitis hurts more with movement and when pressure is applied (sleeping on your side) and causes pain inthe lateral side of your hip and thighs,” says Dr. Domingues.

If your rheumatologist suspects bursitis, you’ll likely undergo a physical exam to test for tenderness as well as imaging (X-rays or MRI) and lab tests (examining fluid from the bursa) to rule out other problems causing your pain.

How It Affects Treatment

Bursitis treatment can include rest, ice, and anti-inflammatory medications as well as steroid injections if the pain does not subside after a week.


While RA can cause soreness of tendons and ligaments due to inflammation in the connective tissues in and around the joints, painful tendons are likely a sign of tendinitis (also spelled tendonitis).

“Tendinitis is an overuse syndrome that causes inflammation and stiffness in the tendons,” says Dr. Domingues. The condition is most common in those over age 40 and athletes. In fact, many forms of tendinitis are named after sports — for example, tennis elbow, golfer’s elbow, pitcher’s shoulder, swimmer’s shoulder, and jumper’s knee. People with such conditions as RA, osteoarthritis, gout, and diabetes are also more likely to develop tendinitis.

Unlike RA, which typically causes pain in the hands, wrist, and feet, tendinitis affects the medium and large-size joints, he adds, including the elbow, around the rotator cuff (the shoulder), and thigh.

Another difference between tendinitis and RA is the progression of the pain. “With RA, you feel worse in the morning, but with tendinitis you’ll start the day okay and feel more pain as you move,” says Dr. Domingues.

If your rheumatologist suspects tendinitis, they’ll perform a physical exam and listen for a “creaky sound” that indicates the tendon sheath is inflamed. Imaging tests, including an MRI, will also be done to look for swelling of the tendon sheath.

How It Affects Treatment

Tendinitis is typically treated with rest, physical therapy, splints or braces, over-the-counter NSAIDs, and corticosteroid injections. Surgery may also be an option if the tendon ruptures.

The bottom line: There are multiple conditions that can cause joint paint (or what may be mistaken for joint pain) that can co-occur with rheumatoid arthritis. By verbalizing exactly where on your body you experience pain, and describing how it feels, what brings it on, how long it lasts, and what, if anything, makes it feel better, you can help your rheumatologist take the guesswork out of diagnosing and treating your pain.

(Video) HOW TO TREAT RHEUMATOID ARTHIRITIS. RA Signs and Symptoms and Management.

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What causes pain in rheumatoid arthritis? ›

RA commonly affects joints in the hands, wrists, and knees. In a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, unsteadiness (lack of balance), and deformity (misshapenness).

What causes joint pain without inflammation? ›

Pain affecting multiple joints in the absence of inflammation may be due to increased joint laxity with excessive trauma, as in benign hypermobility syndrome. Polyarthritis may involve peripheral joints, axial joints (eg, sacroiliac, apophyseal, discovertebral, costovertebral), or both.

What causes pain other than inflammation? ›

These CNS pathways include mechanisms that facilitate pain, as well as mechanisms that inhibit pain. Other factors, such as sleep disturbances, depression, anxiety, and catastrophizing, may also impact the perception of pain in RA patients.

What else can rheumatoid arthritis cause? ›

Normally, your immune system helps protect your body from infection and disease. In rheumatoid arthritis, your immune system attacks healthy tissue in your joints. It can also cause medical problems with your heart, lungs, nerves, eyes and skin.

Can rheumatoid arthritis cause muscle pain? ›

Whole-Body Symptoms

Rheumatoid arthritis symptoms can also go beyond your joints. You could feel: Fatigue. Muscle aches.

Can rheumatoid arthritis be caused by stress? ›

Rheumatoid arthritis (RA) is a chronic inflammatory joint condition and an autoimmune disease that can be caused by stress, according to research. Stress triggers rheumatoid arthritis by setting off the immune system's inflammatory response in which cytokines are released.

Can you have rheumatoid arthritis without inflammation? ›

Sign up here. Inflammation is the root cause of rheumatoid arthritis (RA) pain — but it's certainly not the only cause. In fact, many people with RA experience joint pain without swelling and other types of pain, in spite of having low levels of inflammation, few affected joints, and low disease activity.

What autoimmune diseases cause joint pain? ›

Several autoimmune diseases can cause joint pain and other symptoms that mimic rheumatoid arthritis (RA). These diseases most commonly include lupus, systemic scleroderma, and polymyalgia rheumatic.

What diseases cause all your joints to hurt? ›

Causes of joint pain include:
  • Adult Still's disease.
  • Ankylosing spondylitis.
  • Avascular necrosis (osteonecrosis) (death of bone tissue due to limited blood flow)
  • Bone cancer.
  • Broken bone.
  • Bursitis (joint inflammation)
  • Complex regional pain syndrome (chronic pain due to a dysfunctional nervous system)
  • Fibromyalgia.

What is the most painful type of arthritis? ›

Rheumatoid arthritis can be one of the most painful types of arthritis; it affects joints as well as other surrounding tissues, including organs. This inflammatory, autoimmune disease attacks healthy cells by mistake, causing painful swelling in the joints, like hands, wrists and knees.

Is all pain caused by inflammation? ›

Irrespective of the characteristic of the pain, whether it is sharp, dull, aching, burning, stabbing, numbing or tingling, all pain arise from inflammation and the inflammatory response.

What can be mistaken for rheumatoid arthritis? ›

Conditions That Can Look Like RA
  • Lyme Disease.
  • Psoriatic Arthritis.
  • Sjögren's Syndrome.
  • Gout.
  • Fibromyalgia.
  • Lupus.
Sep 24, 2020

What bacteria causes rheumatoid arthritis? ›

The researchers found that 75% of people with new-onset, untreated rheumatoid arthritis had the bacterium Prevotella copri in their intestinal microbiome.

What are the 7 diagnostic criteria for RA? ›

The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric ...

Can Covid trigger rheumatoid arthritis? ›

Multiple studies have reported autoantibodies in patients with COVID-19, particularly anti-cardiolipin, anti-β2-glycoprotein I and antinuclear antibodies. 1 2 Anti-citrullinated protein antibodies (ACPA) and flaring of rheumatoid arthritis (RA) after SARS-Cov-2 infection have also been described.

Can RA cause nerve pain? ›

RA can hurt your peripheral nerves, which are part of the peripheral nervous system. That's the communication system that helps your central nervous system (brain and spinal cord) send and receive information throughout your body. Most often this damage happens in your hands and feet.

Can arthritis cause pain all over the body? ›

The severity varies from person to person and even from day to day. In some people only a few joints are affected and the impact may be small. In other people the entire body system may be affected. The joints of the body are the site of much of the action in arthritis.

Can rheumatoid arthritis cause neuropathy? ›

RA can progress to a point where it causes nerve damage. Nerve damage, which is also known as neuropathy, causes numbness and tingling. People with RA can have varying degrees of numbness and tingling, depending on the disease's progression.

Can emotional trauma cause rheumatoid arthritis? ›

A history of trauma may increase the risk for developing rheumatoid arthritis or other autoimmune conditions.

Is sun good for rheumatoid arthritis? ›

Living in a sunnier climate may reduce the risk of developing rheumatoid arthritis, according to US researchers. Their study of more than 200,000 women, published in the journal Annals of the Rheumatic Diseases, suggested a link between sunlight and the risk of developing the disease.

Can emotional stress cause arthritis? ›

The longer you're exposed to stress, the more destructive the inflammation can become. In a PLoS One study, people with RA identified stress as a trigger for disease flare-ups. Arthritis symptoms contribute to stress, especially when they're unrelenting.

What blood test is needed for rheumatoid arthritis? ›

A related blood test known as anti-cyclic citrullinated peptide (anti-CCP) test is also available. Anti-CCPs are antibodies also produced by the immune system. People who test positive for anti-CCP are very likely to develop rheumatoid arthritis, but not everybody with rheumatoid arthritis has this antibody.

Can you be misdiagnosed with rheumatoid arthritis? ›

Misdiagnosis of Rheumatoid Arthritis Is Common. Many rheumatic diseases have overlapping symptoms, and that can complicate the effort to obtain an accurate diagnosis for RA. Some diseases are complex. They may have overlapping characteristics with other conditions, making diagnosis more difficult.

What blood markers indicate RA? ›

People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, also known as sed rate) or C-reactive protein (CRP) level, which may indicate the presence of an inflammatory process in the body.

What is lupus joint pain like? ›

Lupus can also cause inflammation in the joints, which doctors call “inflammatory arthritis.” It can make your joints hurt and feel stiff, tender, warm, and swollen. Lupus arthritis most often affects joints that are farther from the middle of your body, like your fingers, wrists, elbows, knees, ankles, and toes.

What are the 7 autoimmune diseases? ›

Common autoimmune disorders include:
  • Addison disease.
  • Celiac disease - sprue (gluten-sensitive enteropathy)
  • Dermatomyositis.
  • Graves disease.
  • Hashimoto thyroiditis.
  • Multiple sclerosis.
  • Myasthenia gravis.
  • Pernicious anemia.
Apr 24, 2021

What is the best medication for rheumatoid arthritis pain? ›

Methotrexate is usually the first medicine given for rheumatoid arthritis, often with another DMARD and a short course of steroids (corticosteroids) to relieve any pain. These may be combined with biological treatments.
The DMARDs that may be used include:
  • methotrexate.
  • leflunomide.
  • hydroxychloroquine.
  • sulfasalazine.

Why do all of my joints hurt all of a sudden? ›

Sudden joint pain that occurs all over the body may signal the onset of a chronic condition, such as osteoarthritis, lupus or fibromyalgia, or even an infectious disease such as influenza or the mumps.

What vitamin is good for joint pain? ›

Vitamin D is important for keeping bones strong and preventing injuries from falls. Research shows that people with low levels of vitamin D may have more joint pain.

Why do all my joints and muscles hurt? ›

Viral infections, rash, or fever may make joint movement painful. Injuries, such as broken bones or sprains. Tendinitis is an inflammation of the tendons, or the flexible bands that connect bone and muscle. It is typically seen in the elbow, heel, or shoulder and is usually caused by overuse.

Why is my RA pain worse at night? ›

One theory is that the body's circadian rhythm may play a role. In people with rheumatoid arthritis (RA), the body releases less of the anti-inflammatory chemical cortisol at night, increasing inflammation-related pain.

Does RA show up on xrays? ›

X-rays can show whether (and how much) joint damage you have, though damage may not show up early on. Magnetic resonance imaging (MRI) and ultrasound give a more detailed picture of your joints. These scans aren't normally used to diagnose RA, but they can help doctors find it early.

Is rheumatoid arthritis a disability? ›

Is Rheumatoid Arthritis a Disability? Simply being diagnosed with rheumatoid arthritis does not qualify you for disability. However, if your ability to work is greatly affected or impaired by your condition, then with the proper documentation, you may be entitled to SSA disability benefits.

What is difference between pain and inflammation? ›

Pain results when the buildup of fluid leads to swelling, and the swollen tissues push against sensitive nerve endings. Other biochemical processes also occur during inflammation. They affect how nerves behave, and this can contribute to pain.

Does sugar cause inflammation? ›

Sugar. Unfortunately, sugar is on top of the list of foods that may increase muscle and joint inflammation. Numerous studies suggest that processed sugars release pro-inflammatory substances in the body, causing further inflammation in the joints.

Which enzyme is responsible for pain? ›

Lysozyme, a bacteria-gobbling enzyme commonly known for its role in fighting infections as part of the innate immune system, may serve a previously unrecognized role in facilitating chronic pain after nerve injury.

Can rheumatoid arthritis be a symptom of something else? ›

Lupus. When lupus, a systemic autoimmune disease, affects the joints, it can cause symptoms similar to RA. Most people with lupus also experience flares, where symptoms get worse, then improve or disappear. Other similar signs of lupus and RA include fatigue, fever, and dry eyes.

Can lupus be mistaken for rheumatoid arthritis? ›

When lupus affects the joints, the symptoms can mimic those for RA: pain, stiffness, and swelling. Typically, they're not as bad with lupus. You also may have other symptoms that are common with RA, such as a mild fever, weight loss, and dry eyes. Lupus can trigger some distinct symptoms of its own.

What is rheumatoid arthritis without rheumatoid factor? ›

If you're seronegative for rheumatoid arthritis (RA), you may or may not have RA. It can make it harder to get an RA diagnosis. Being seronegative for RA means that a blood test doesn't find certain antibodies your body typically makes when you have the condition.

Is rheumatoid arthritis pain sharp? ›

A person with RA may feel intense pain in their joints during flares. This may feel like sustained pressure, a burning sensation, or a sharp pain. However, people with RA may also experience periods of remission when they feel few to no symptoms. In addition to causing pain in the joints, RA can affect the whole body.

How does rheumatoid arthritis affect muscles? ›

As the disease progresses, it will affect tendons, ligaments, and muscles. These symptoms will eventually lead to range-of-motion problems and difficulty with moving your joints. Long-term inflammation in affected joints will cause those joints to become damaged and deformed.

What is the so called joint pain protein? ›

Dairy contains a high level of protein casein. This type of protein triggers inflammation and pain in the joints, and may even contribute to irritation around the joints. Some dairy products, such as butter, contain a high amount of saturated fat.

What are the 4 stages of rheumatoid arthritis? ›

The four stages of rheumatoid arthritis are known as synovitis, pannus, fibrous ankylosis, and bony ankylosis.
  • Stage I: Synovitis. During stage I, you may start having mild symptoms, including joint pain and joint stiffness. ...
  • Stage II: Pannus. ...
  • Stage III: Fibrous Ankylosis. ...
  • Stage IV: Bony Ankylosis.
Oct 12, 2021


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