Stages and Progression of Rheumatoid Arthritis (RA)

Rheumatoid arthritis (RA) is an autoimmune disease that affects different individuals in different ways. While in some it can manifest as a mild to moderate disease, and in others, it can be a severe condition. The symptoms of Rheumatoid arthritis (RA) also vary from person to person. Without effective treatment, Rheumatoid arthritis (RA) symptoms will worsen over a period of time, while progressing through specific stages. There is no specific timeline for how or when the disease progresses, but there are many new treatments available that can successfully slow down or even block the disease from progressing. Read on to learn how the stages and progression of rheumatoid arthritis vary from person to person.

How To Recognize RA Progression?

Most patients of Rheumatoid arthritis (RA) go through a gradual worsening of their symptoms. There are some periods of relief or remission, where the condition becomes more manageable. At other times, your Rheumatoid arthritis (RA) symptoms will flare-up, causing them to become more intense and severe.

While there is no exact timeline for determining the progression of Rheumatoid arthritis (RA), how your disease progresses depends on many factors. These include:

  • Stage of Rheumatoid arthritis (RA) at the time of diagnosis
  • Whether or not there is any family history of Rheumatoid arthritis (RA)
  • Your age at the time of diagnosis
  • Presence of certain specific antibodies in your blood
  • Any disease trigger that is specific to you

Keeping these factors in mind, your doctor will help you get a better understanding of how your condition is expected to progress. However, remember that it is actually impossible to predict exactly how Rheumatoid arthritis (RA) will progress over a period of time in different people. In fact, even if there are other members of your family who have Rheumatoid arthritis (RA), it is very much possible that your condition will progress differently than theirs.

According to the John Hopkins Arthritis Center(1), the typical course of progression for Rheumatoid arthritis (RA) in most people includes flare-ups of the disease with severe symptom activity. Over a period of time, these flare-ups become more challenging and lengthier.

Another commonly observed pattern that occurs is that patients start experiencing stronger attacks in the early stages of the disease, followed by a period of minimal disease activity. Nearly 10 percent of all people who have Rheumatoid arthritis (RA) start falling into spontaneous remission within the first six months from the initial onset of their symptoms. Remission from Rheumatoid arthritis (RA) is known to have a precise medical definition and it denotes that your Rheumatoid arthritis (RA) disease activity has stopped for the time being. It has also been seen that this group of people do not have certain antibodies that have been observed in other people with Rheumatoid arthritis (RA).

What are the Stages of Rheumatoid Arthritis?

Many changes occur in the body as Rheumatoid arthritis (RA) keeps progressing from one stage to another. Some of these changes you will be able to see and feel, while others you will not be able to perceive. Each stage of the disease also comes with different treatment goals.(2)

Stage 1 of RA

Stage 1 is the starting stage of Rheumatoid arthritis (RA). At this early stage, many people may feel joint stiffness and joint pain or witness some swelling around the joints. During this first stage, there is inflammation present inside the joint, due to which the tissue in the joint becomes inflamed. At this stage, there is no damage caused to the bones, but there is inflammation to the joint lining, which is known as the synovium.

Stage 2 of RA

Stage 2 can be described as a moderate stage of Rheumatoid arthritis (RA). In stage 2 of the disease, the synovium’s inflammation starts to cause damage to the joint cartilage. Cartilage is the tissue that acts as a covering for the end of the bones at the site of joints. When the cartilage gets damaged, people start to experience loss of mobility and also start to experience pain. There is an effect on the range of motion as well as movement starts becoming limited.(3)

Stage 3 of RA

Once your disease progresses to stage 3, it is now considered to be severe arthritis. At this stage, the damage not only extends to the cartilage, but also to the bones. By this stage, the cushioning between the bones has already become worn out, they start to rub together. This causes more pain and swelling. Some people will also start experiencing more loss of mobility as well as muscle weakness. There is bone erosion, causing the bone to become damaged and some type of bone deformity may also occur.

Stage 4 of RA

Stage 4 is known as end-stage Rheumatoid arthritis (RA). At this stage, there is no longer any inflammation present in the joint, as the joints no longer function. In stage 4 Rheumatoid arthritis (RA), some people may still be experiencing swelling, stiffness, pain, and loss of mobility. There is a decrease in muscle strength and the joints become damaged to the extent that the bones become fused together, a condition known as ankylosis.

Progressing through all the four stages of the disease can take years, though in some cases patients won’t progress through all the stages during their lifetime. Some patients go through periods of having no RA activity, indicating that the condition has gone into remission.

Is There Any Treatment for Rheumatoid Arthritis?

Your doctor will consider many different medication options and also formulate a treatment plan for your individual condition. Your treatment plan will primarily depend on your overall health and which stage of Rheumatoid arthritis (RA) you are at, along with the severity of your symptoms and degree of inflammation. Your doctor will also consider the extent of time you have been living with RA.

There are different types of commonly used medications for Rheumatoid arthritis (RA) which perform different roles. For examples, when doctors prescribe steroids and NSAIDs (non-steroidal anti-inflammatory drugs), these are typically to help with inflammation. You may also be presented DMARDs (disease-modifying anti-rheumatic drugs) to help save your joint tissue. DMARDs are also prescribed to slow down the progression of RA. Biologic drugs may also be prescribed, which work on your immune system to change the inflammatory response of your body.

People who have reached the later stages of the disease might be recommended to undergo surgery. The goal of surgery in the later stages of Rheumatoid arthritis (RA) is to help achieve some improvement in the day-to-day functioning of the patient, reduce pain, or attempt to repair the damage caused by RA. In some cases, surgery might be able to remove the nodules or synovium, fuse the joints together, or repair the tendons. Surgery can also be used to replace a joint completely.

Apart from these treatment options, living a healthy lifestyle is one of the best ways of managing RA. Your doctor will recommend which lifestyle choices you should follow in order to complement your treatment plan. For example, exercising regularly will help improve your muscle strength. However, you will be advised on the type of exercises to do as they have should not put too much pressure on your joints. At the same time, it is important to keep your stress levels under control and also maintain a healthy weight as this will make it easier for you to manage Rheumatoid arthritis (RA) symptoms at various stages. Also, quit smoking if you are a smoker as smoking is a known cause that leads to a worsening of your symptoms.(4)

Conclusion

Rheumatoid arthritis (RA) is a chronic and progressive disease, but it does not progress in the same manner in all people. There are treatment options for the disease that help you manage your symptoms, as well as lifestyle approaches, will also help patients manage their symptoms. It can also help slow down the progression of the disease and even prevent disease progression altogether. Depending on your symptoms and other factors such as your overall health, your age, etc., your doctor will come up with a customized treatment plan for you.

References:  

  1. Information, D., Arthritis, R., Arthritis, P., Spondylitis, A., Disease, L., Corner, P., Sheets, A., Arthritis, M., Patients, E., Expert, A., Research, O., Research, P., Studies, R., Fund, T., Us, A., Information, A., Us, C., Faculty, O., Staff, O., Centers, R., Information, A. and Arthritis, R. (2019). Rheumatoid Arthritis Symptoms : Johns Hopkins Arthritis Center. [online] Johns Hopkins Arthritis Center. Available at: https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-symptoms/ [Accessed 13 May 2019].
  2. van de Sande, M.G., de Hair, M.J., van der Leij, C., Klarenbeek, P.L., Bos, W.H., Smith, M.D., Maas, M., de Vries, N., van Schaardenburg, D., Dijkmans, B.A. and Gerlag, D.M., 2011. Different stages of rheumatoid arthritis: features of the synovium in the preclinical phase. Annals of the rheumatic diseases, 70(5), pp.772-777.
  3. Stack, R.J., Sahni, M., Mallen, C.D. and Raza, K., 2013. Symptom complexes at the earliest phases of rheumatoid arthritis: a synthesis of the qualitative literature. Arthritis care & research, 65(12), pp.1916-1926.
  4. Kahlenberg, J.M. and Fox, D.A., 2011. Advances in the medical treatment of rheumatoid arthritis. Hand clinics, 27(1), pp.11-20.

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