The 4 Stages of Rheumatoid Arthritis

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Anyone who has ever suffered from rheumatoid arthritis knows the struggle that comes with this chronic inflammatory autoimmune disease that attacks nerves and leaves the afflicted in sometimes debilitating pain.

According to Victoria Ruffing, RN, and Dr. Clifton O. Bingham III, the chance of developing rheumatoid arthritis increases up to 5% for women over the age of 55, and that overall, women experience the disease “two to three times great…than men.”

Although this disease is not fully understood by medical professionals across the globe, four different stages have been identified leading up to full-blown rheumatoid arthritis.

While no two patients will experience the exact same symptoms, the article below will outline the general stages and what can be expected during the disease’s development.

Stage 1: The inflammation begins.

According to the Rheumatoid Arthritis Support Network, the early stages of the disease will cause see painful joint inflammation and be swelling of the “synovial tissue.”

This tissue, also known as the synovial membrane, is the thin connective tissue that encapsulates the joints, keep all the moving parts together, and prevent those parts from grinding against one another.

When this tissue becomes swollen, it begins to impede the function of the joints, making them stiff and painful.

The joints most often affected are those in the hands, wrists, and feet, with some cases claiming pain in shoulders, elbows, or knees.

Stage 2: Moderate pain and the beginning of noticeable internal damage.

As the synovial degeneration continues, the pain involved with rheumatoid arthritis will begin to increase drastically.

Individuals may notice that their joints are moving even less because it is likely that the inflammation has begun to cause cartilage damage.

Dr. William C. Shiel, Jr., explains that at any time, symptoms can go into remission and the individual will feel much better.

But it is just as likely that at any time those symptoms will reappear, or “flare”, and the inflammatory pain will start all over again.

Symptoms of active rheumatoid arthritis flares (beyond joint pain and stiffness) include a sense of fatigue or loss of energy as well as a loss of appetite or even low-grade fever.

Stage 3: The damage has moved from the cartilage to the bone, and the condition has become severe.

By stage three, the pain caused by rheumatoid arthritis is nearly unbearable. Afflicted individuals will find it difficult, if not impossible, to perform daily tasks that can include walking if the inflammation is center in the legs or feet and/or any tasks that involve the hands if the inflammation is centered there.

In her article “Treating Severe Rheumatoid Arthritis: How Treatment Options Change in Stage 3 Disease” (medically reviewed by Dr. Grant Hughes), journalist Carol Eustice explains that depending on the degree of severity, the inflammation might also begin to affect other organs throughout the body, which can include:

  • Pericarditis – affects the area around the heart
  • Vasculitis – affects the blood vessels
  • Pleuritis – affects lung tissue

In addition to the increased chance of inflammation around vital organs, stage three rheumatoid arthritis can also see the development of joint deformities in the affected areas.

These deformities often appear as solid nodules that physically affect the appearance of an individual’s hands, feet, legs, or other joints the disease may be affecting.

Stage 4: The end game, and the full deterioration of join movement.

Known as end-stage rheumatoid arthritis, stage four is the most advanced stage of the disease known to modern medicine.

By this point, the joint damage has reached a severe, nearly irreversible point and movement on the part of the individual affected is next to impossible.

Stage four rheumatoid arthritis under an X-ray is likely to show severe cartilage and bone damage, as well as possible, severe joint deformity and muscle degeneration.

Even at this stage of the disease, remission can still happen and medical professionals have no way to explain how or why this happens.

It is still unlikely, and therefore it is important to continue seeking proper medical care to try and control the disease.

Are there any treatment options?

While there is no cure for rheumatoid arthritis, there are a few options in terms of treatment that may at least help to suppress the symptoms and progression of the disease.

Disease Modifying Anti-Rheumatic Drugs (DMARDs)

DMARDs were the most popular form of treatment in the 1970s, according to doctors J. Michelle Kahlenberg and David A. Fox, and while the medication is still used today, there is a plenty of unknown factors associated with timing and effectiveness that make the drug work for some but not others. Research is continuing to grow in this area to try and find the right balance for patient treatment.

Biologic DMARDs

More expensive than typical DMARDs, biologic DMARDs are designed to specifically target those receptors that are integral to the creation and progression of rheumatoid arthritis.

Kahlenberg and Fox claim this new form of DMARD is revolutionary, but more clinical trials are needed to fully explore the options included with this biologic variant.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are available over the counter or in prescription strength and include such medications as ibuprofen an naproxen.

Steroidal Medication

The Mayo Clinic offers corticosteroids as a possible treatment option, as they are designed to reduce inflammation. The most common of these is prednisone.

Physical Therapy

A physical therapist can train an individual in different joint exercises that will help keep them flexible and build up muscle.

According to the Mayo Clinic, a physical therapist “may also suggest new ways to do daily tasks, which will be easier on your joints.” A trained therapist knows how the body works and can cater assistance to specific needs.


When the damage becomes too great, it may be time to turn to surgical procedures to repair, fuse, or replace cartilage or tendons.

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