Unilateral vs bilateral joint pain

Hi all :-)

Does RA/RD usually affects joints on both sides of the body at the same time?

Is it possible to have joints affected mainly on one side, or different joints on each side of the body?

So far, the affected joints are mostly on the left side - fingers, wrist, jaw, shoulder then right knee and hip transient pain and swelling but persistent pain and stiffness in left side joints. Only my feet are really 'together' and both sore.

Will get a DX next week, hopefully, just wondered if this is normal for RA/RD?

18 Replies

  • Fairly normal I think. Symmetry is in the text books, but our bodies don't tend to read the books! I always have one side worse than the other, and sometimes just one side alone. I can also have painful left foot, right knee and right hand at the same time....so not very regular at all.

    Never seems to bother my rheumy as all the other signs were clear. Diagnosis is a bit of a jigsaw, so if a few pieces are missing it doesn't matter as long as there are enough to see what the picture is.

  • Hi

    Rheumatoid arthritis is a very varied condition. It 'tends' to be symmetrical, but can affect one side more than the other and sometimes isn't symmetrical at all, or at least starts off not being symmetrical. It also 'tends' to affect multiple joints, as you have, yet some people we speak to say it started in one joint and it was some time before it started to affect others.

    Think of the list of 'typical' symptoms and test results as a list of clues to it being RA. In some cases people might have every 'clue' on the list, but in many they have some but not others. That's why it takes a specialist to look through these clues and determine whether it is RA or something else. Looking for it to be symmetrical is one clue, but if you have enough of the other clues they can still diagnose it as RA.

    Hope that helps.


  • This disease is a law unto itself. Before an appointment I try and work out which parts have hurt most over the previous few weeks but for the one week it can be a totally different areas to the other. For a long time I only had the left knee affected before the right joined in and then hands now shoulders, left side jaw and some toes. You may need to ensure you emphasis feet as the DAS score which rhuemys use as part of a calculation of disease activity does not include feet. For me the hip pain was muscular rather than joint and a range of exercises from physio helped. Farm

  • Also remember there are other types of inflammatory arthritis that can look similar - RA is just the most well-known. And that your pain can be caused by a mixture of inflammatory arthritis and osteoarthritis. Maybe look up psoriatic arthritis and ankylosing spondylitis before your appointment to see whether your symptoms are consistent with either of these...?

  • Ankylosing spondilitis rang a few bells when I looked it up! When the rheumy examined me she was very interested in fingers/toes but not so much back/neck which have had probs with for a long time. Will mention it at appt. Xxx

  • Rheumatoid arthritis tends to be symmetrical; spondyloarthritis (another form of inflammatory arthritis that usually has significant spine involvement) tends to be asymmetrical. But that doesn't work for 100 percent of cases.

  • Am wondering about that now, spine/neck probs for a long time, not really investigated, gp put it down to osteoarthritis. Sometimes back feels like it's on fire running up and down spine (inside it, if you know what I mean)

    Am making notes to mention at rheumy appt. as she was only in the room for a few mins. last time and forgot to mention a few things which seem relevant now.

  • Hello MrsBones123 . For me it's usually symmetrical. On both sides but always one side seems more severe than the other. For example my right hand is always more painful than the left. Probably because I use my right more. If I get a flare then the right always is worse. But I get jaw pain in my left jaw and not the right. So I guess it really depends on the person. 😊 I hope you're doing well today.

    Cas xx 🌻🍀

  • Thanks Cas, hope you are doing well today too xxx

  • Are you left-handed by chance?

  • Yes I am left handed. Nuisance that that's the hand it's really 'going for' at the moment.

  • Well, there you have it. My theory holds. Generally (I think) your dominant hand/side is the one affected more when things aren't perfectly symmetrical. Lately, the disease for me moves through my body like a puppy coming home to a new house - it hurts here, then there, then over there, there, there. I go to bed with a sore wrist, elbow and knee and wake up with sore feet, thumb, other knee and a shoulder! Then the next day, it will be different still. But definitely not symmetrical these days (it started out that way, which I suppose helped for diagnosis).

    Gentle hugs to you!

  • I like your puppy analogy, it's a gentler image than the one I have of a tiger seeking prey, lol.

    Isn't it strange how it seems to 'try joints out' to find out where it wants to go next?

    Also, how it 'knows' which is your dominant side.

    Hope your puppy isn't being too boisterous today, but curled up having a snooze ;-)


  • No in the years I have had this, mine tends to move around alot but never yet been symmetrical in me. I'm sure that pleasure is yet to come. Every one is different and unique.

  • Thanks everyone for your replies! So helpful and given me some food for thought to be prepared for my short time with rheumy. :-) xxx

  • mine is predominantly the left side,but I am right handed

    the only joint affected on the right is my elbow,but my left is elbow,fingers,knee and ankle

  • twas 4me - left ankle n foot at beginning cdn't walk, agony. then 6m later left hand n wrist, now mtx w/drawn it's right ankle and foot also right wrist. also elbos shldrs come n go - bit like that film ALIEN .. wanndering round my body doesn't know where 2 settle. seeing rheumy tuesday .. in w/chair n hoping i get my mtx back

  • Hope you have a helpful rheumy appointment tomorrow GranAmie, and get back onto an effective treatment.

    Yes, it is like Alien. I suppose 'it' thinks we are alien in a way.

    Four months on from writing this question, it's still mainly left side. xx

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