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  • Dr. Chris Phillips

What are the Four Stages of Rheumatoid Arthritis?



Rheumatoid arthritis (RA) is not just an autoimmune disease, it’s a progressive disease. A progressive disease is a type of medical condition where symptoms continue to worsen over the span of years.


Furthermore, RA is a chronic inflammatory condition with no known cure. The ongoing inflammation that goes hand-in-hand with RA is a result of the immune system attacking itself and mistaking healthy cells for foregin cells.


What does this mean for patients living with RA?


As with all autoimmune conditions, disease progression plays out differently for every patient. The timeline of progression varies from patient to patient, and there is no way to determine the exact speed or severity of the progression.


When it comes to tracking the development of RA, the disease progression is divided into four stages:


Stage 1 = Early-Stage RA


In Stage 1, a patient can experience mild symptoms or no symptoms at all.


Even if a patient is not outwardly showing symptoms, their insides might indicate otherwise. Some patients with RA develop a type of antibodies that are detectable in the blood, and these disease markers can be present before a patient presents symptoms.


On the other hand, some patients start to show symptoms during Stage 1. Perhaps a patient will feel “off” from what they consider their normal health and well-being, or maybe the disease has progressed enough to already cause inflammation in the joints.


In the beginning, RA goes after tiny joints. More specifically, it goes after the tissues within those tiny joints, known as the synovial membrane or synovium.


When an autoimmune disease attacks those synovial tissues, the joints become inflamed. Since the hands and feet have plenty of synovial joints, patients often feel their first symptoms in their hands and feet.


Symptoms might include:

  • Joint pain

  • Joint stiffness

  • Joint warmth

  • Joint redness

  • Joint swelling

  • Joint tenderness


RA can be difficult to diagnose during Stage 1, though. Symptoms may not be obvious, and symptoms can come and go.


Plus, the early stages of other autoimmune diseases can look similar to the beginning stages of RA. Symptoms tend to overlap, making it a challenge to know the underlying source of those symptoms.


Stage 2 = Moderate-Stage RA


In Stage 2, the cartilage of a synovial joint is impacted. Cartilage is a necessary component of a healthy joint.


The synovium connects to cartilage and helps the joint function as it should. Also, cartilage cushions the joint bones. It covers the end of the bones and provides support to the joint.


The continued inflammation that comes with RA causes the cartilage to thin, which leaves the bone without cushioning. Without cushioning, patients might experience:

  • Increased pain

  • Prominent swelling

  • Enhanced weakness

  • Loss of mobility

  • Limited range of motion


As the cartilage thins, the joint is now set up for permanent bone damage as well. The bone that sits next to the thinned cartilage may begin to erode due to the lack of protective support.


During Stage 2, those detectable antibodies come out in full force (if not visible in blood work during Stage 1). Remember, it is possible to have RA and not have those antibodies, but a rheumatologist may order other blood tests that could indicate the presence of prolonged inflammation. Some patients will have above average amounts of C-reactive Protein (CRP) in their blood during Stage 2.


Stage 3 = Severe-Stage RA


Stage 3 is when RA has progressed through the synovial membrane, through the cartilage, and is affecting the bone.


As the joints rub bone on bone, bone erosion occurs. This often leads to joint deformities and other physical impairments of the joint. The fingers on the hands could become twisted, bent, or crooked with thickened knuckles, and other visual nodules or bumps on the joints might be apparent.


In addition, the tendons can now feel the impact of RA. As the joint continues to deteriorate, the tendons can rupture or become compressed.


During prior stages of RA, a patient might undergo imaging tests to confirm and check on the damage in their joints. By Stage 3, the damage is visually noticeable, and imaging tests like a CT scan and MRI scan are not as needed.


Stage 4 = End–Stage RA


By Stage 4, the joints are no longer working as they should and normal joint function is compromised. Joint tissue inflammation is not as prominent, since the structure of the joint is already destroyed.


In fact, it’s as if there is no joint at all. The bones that once made up a movable, bendable joint are now fused together. These fused bones make mobility near impossible, and a person can lose the ability to perform daily tasks.


Treatment Options During the Four Stages of RA


The pace of progression depends on numerous factors. The severity of symptoms also depends on several components.


All in all, receiving treatment as early as possible is the best way to decrease symptoms, reduce RA progression, and prevent the onset of permanent joint damage.


Here at Paducah Rheumatology, our healthcare team can treat all four stages of RA.


Whether you suspect you have RA or have lived with that diagnosis for years, we are ready to help you live a fulfilling life even amongst the challenges that come with RA.


We are accepting new patients with a physician’s referral. Give us a call at 270-408-6100 today.


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