Symptoms of rheumatoid arthritis can be related to the joints themselves or may be systemic (involving the whole body). Symptoms typically come and go and result from inflammation. Joint aches and stiffness, muscle aches, low-grade fever, fatigue, lack of appetite, and loss of energy are characteristic of active disease. Joints can become warm, swollen, reddened, painful, and tender. Joint pain and stiffness, particularly early in the morning, are often early symptoms. Usually, multiple joints on both sides of the body are affected. Depending on the specific joints that are affected, other possible symptoms include limping, hoarseness, and painful walking. In children, crying, irritability, and poor appetite are often observed. Firm lumps or firm bumps under the skin (subcutaneous nodules called rheumatoid nodules) can occur around the elbows and fingers where there is frequent pressure.