What are the 4 Stages of Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is an inflammatory and progressive condition affecting the joints. It is an autoimmune disease caused by the immune system attacking healthy cells, leading to inflammation. Common symptoms include pain, stiffness, tenderness, red and swollen joints, and fever. 

RA varies substantially between individuals. It can be mild, moderate, or severe and can progress quickly or slowly. Nonetheless, RA is a degenerative condition that continually worsens over time. Some patients have heard about various stages of RA, asking, "what are the 4 stages of rheumatoid arthritis?" 

That's what we're answering in this post. We'll explain:

• What are the 4 stages of rheumatoid arthritis?

• How do you identify progression?

• What treatments can slow progression?

• Can RA patients enter remission?

What are the 4 stages of rheumatoid arthritis?

Stage 1 – Pre-Clinical RA

During stage 1, the characteristic symptoms of RA may not yet be evident. However, as the disease processes have begun, some markers may be detectable in your blood, e.g., rheumatoid factor and ACPA (anti-citrullinated protein antibodies). Around one in five people are seronegative, meaning no disease markers can be found in their blood, regardless of stage. 

Stage 2 – Early RA

In early RA, symptoms begin to occur. The most common symptom is morning stiffness in the joints. This typically lasts around an hour, alongside joint pain and swelling. Patients may also notice morning stiffness in their hands – for example, being able to make a fist upon waking up.

According to the American College of Rheumatology, early RA falls within less than six months of the first symptoms. There is no uniform consensus, however, as some rheumatologists believe early RA can last up to two years after first symptoms.

Stage 3 – Late or Established RA

Late or established RA occurs after a set period of time (usually six months to two years) and is determined by the symptom severity. Specific deformities like the subluxation of the joints or partial dislocation are identifiable. 

While RA is closely associated with the joints, established RA can damage other body parts, including the eyes, heart, lungs, and skin. 

The goal at this stage is to enter remission by lowering disease activity. Complex, potent medications are administered to dampen the immune system and prevent further joint deterioration.

Stage 4 – End-Stage RA

Last, patients may enter end-stage RA. Considering advances in medicines, it's rare to reach end-stage RA today. The damage is so severe at this stage that joints can fuse together. Complete loss of function has occurred. As long as your treatment is helping other joints, your doctor will likely continue your treatment plan.

How do you identify progression?

The most obvious sign RA is progressing is the gradual worsening of symptoms. While initially, morning stiffness may be the only symptom, deformities in the hands and other joints can become evident as the disease progresses. 

Your rheumatologist will also monitor disease markers. The condition produces these markers, and so indicates its severity. In some patients, severe attacks occur initially, followed by periods of minimal disease activity. In less than 10 pc, patients fall into spontaneous remission in the first six months. 

RA is a partially inherited condition. However, the course of your family members' condition does not dictate your prognosis. For most people, the disease involves flare-ups of high disease activity, with flare-ups becoming longer.

What treatments can slow progression?

First-line treatment involves a range of medications, including:

• NSAIDs (like naproxen or ibuprofen) and steroids to relieve inflammation.

• Disease-modifying antirheumatic drugs (DMARDs) suppress your body's immune and inflammatory responses, slowing the condition.

• Biologic drugs also alter your body's inflammatory response.

Following medications, surgical options can be explored for Stage 3 or even Stage 4 patients. Common surgeries may involve:

• Repairing tendons

• Removing nodules or synovium

• Fusing joints

• Joint replacement

In addition to medical and surgical interventions, simple lifestyle interventions can help manage RA. For example, exercise strengthens joints, stress reduction relieves the immune system, and smoking cessation calms inflammation.

Can RA patients enter remission?

Yes. Remission is defined as a period with little to no disease activity. If this period lasts several months, it is known as sustained remission. 

Remission is not uncommon throughout RA progression. Indeed, current rates of remission range from 10 to 60 pc or more – and rates are increasing as new treatments become available.

Final thoughts

RA is a progressive disease defined by four stages. However, while these stages are important from a clinical perspective to patients, the disease is continuous. Most important is finding a treatment to relieve and stop the disease progression.

Speak to our expert podiatric team if you are suffering from RA or have noticed any similar symptoms.