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Rheumatoid arthritis is an autoimmune disorder that causes pain and swelling in the joints. To fully understand this chronic condition, it helps to understand the four stages that characterize it.
The stages of rheumatoid arthritis help practitioners determine how advanced the disease is. Diagnosis and treatment strategies vary depending on the stage of rheumatoid arthritis. This article will share an overview of the four stages of rheumatoid arthritis including differences in treatment and diagnosis.
What is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a chronic condition that affects the joints. This chronic condition happens when the immune system accidentally attacks itself, mainly targeting the joints. Although rheumatoid arthritis mainly causes symptoms associated with the joints, it can affect other areas of the body including the skin, eyes, lungs, blood vessels and heart.
Understanding The 4 Stages of Rheumatoid Arthritis
Symptoms of Rheumatoid arthritis will vary as the disease progresses. The stages of RA are used to help determine how advanced the disease is and can help with finding the best treatment and management of the disease. Each stage will involve varying severity of symptoms and treatments may vary. The four stages of rheumatoid arthritis include:
- Stage 1: Early RA
- Stage 2: Antibody formation and mild RA
- Stage 3: Moderate RA
- Stage 4: Severe RA
Stage 1: Early Rheumatoid Arthritis
Understanding the signs of early rheumatoid arthritis is important since catching the disease early can improve treatment outcomes. In stage 1, there is inflammation and swelling in the joints. Another common symptoms of stage 1 is joint stiffness. During this stage, most people will feel these mild symptoms in smaller joints such as those in the fingers and feet.
Diagnosing stage 1 RA usually involves blood testing to look for certain markers such as rheumatoid factor and c-reactive protein. Your doctor may also recommend imaging tests such as X-rays or MRIs to look for early signs of joint damage. Receiving appropriate treatment during the early stage of RA might help to slow the progression of the disease.
Stage 2: Antibody Formation and Mild Rheumatoid Arthritis
In stage 2 of rheumatoid arthritis, the body is beginning to form antibodies such as rheumatoid factor. Rheumatoid factor is a group of antibodies that attack healthy cells in the body. Normally, antibodies are only supposed to attack germ cells or those that could invade the body and make you sick, in autoimmune disorders like RA, the body’s immune system mistakenly attacks healthy cells.
Once RA reaches stage 2, symptoms may become more persistent and might even spread beyond the smaller joints in the body. Getting treatment during this stage can also help to slow down the progression of the disease. Common symptoms in stage 2 include:
- More persistent and obvious joint pain
- More noticeable joint swelling
- Joint stiffness that is usually worse in the morning
- Less range of motion in joints that are affected
Some of these symptoms can also be experienced by those with osteoarthritis.
Stage 3: Moderate Rheumatoid Arthritis
Stage 3 is also known as moderate RA. During this stage, the disease has become more severe with damage reaching the cartilage and bone breakdown beginning. At this point, cushions between bones have worn away causing the bones to rub together.
Because joint damage becomes more severe in this stage, physical symptoms may be more evident such as twisted fingers and thickened knuckles. Other common characteristics and symptoms of stage 3 RA include:
- Severe pain
- Rheumatoid nodules or firm lumps under the skin
- Development of carpal tunnel syndrome
- Diagnostic imaging showing joint damage
Stage 4: Severe Rheumatoid Arthritis
Stage 4 rheumatoid arthritis is considered severe RA or end-stage RA. By this stage, the joints will no longer function as they are supposed to. There still may be pain, swelling and stiffness in the joints as well as decreased range of motion and difficulty using the hands or parts of the body that are affected. Symptoms of stage 4 RA include:
- Extreme pain and swelling
- Joint deformity
- Extremely limited range of motion
Recognizing The Signs of Rheumatoid Arthritis Progression
Rheumatoid arthritis is a progressive disease, meaning that it typically will worsen slowly over time. People with RA will have periods in which symptoms worsen or improve, including stages of remission and flare-ups. How the disease progresses will vary depending on several factors including:
- Family history
- Your age at the time of diagnosis
- Stage of RA at the time of diagnosis
- Specific disease triggers
- Presence of certain antibodies in your blood
- Lifestyle factors such as whether you’re a smoker or not
Your doctor will consider these factors to help with determining whether the disease is progressing and determining the best treatment approach.
Treating Rheumatoid Arthritis: A Stage-by-Stage Approach
Treatment approaches vary depending on what stage of the disease you are in. In determining the best treatment approach for you, your doctor will also consider your symptom severity, how long you’ve been diagnosed with RA and whether you have other health conditions.
Treatment for Early RA
In its early stages, treating RA can be crucial in preventing the disease from progressing. In the early stage of RA, your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to help reduce inflammation. Disease-modifying antirheumatic drugs (DMARDs) are also common in early RA since they help to prevent joint damage.
Treatment for Moderate RA
In the moderate stages, treatment for RA typically involves the use of DMARDs as well as biological agents. Physical therapy may be recommended to help improve joint function and range of motion.
Treatment for Severe RA
Once RA reaches the severe stage, your doctor may recommend additional medications such as biologic DMARDs that target specific parts of the immune system, helping to lower levels of inflammation. As a last resort, joint replacement surgery may be recommended.
Having a strong support system is essential when managing a chronic disease like rheumatoid arthritis. Handling the challenges that come with a disease like rheumatoid arthritis as it progresses is challenging for anyone. It is important to lean on family and friends or join a local support group while dealing with the progression of RA.
Effective Pain Relief Strategies
Finding effective ways to manage the pain that comes with RA can help improve quality of life and make it easier to live with RA. Some common approaches to managing RA pain include:
- Acupuncture
- Heat and cold therapy
- Regular exercise to keep muscles strong
- Drug therapy with NSAIDs, corticosteroids, or DMARDs
The best pain management strategy will look different for each individual. It is important to work closely with your doctor to determine the best unique pain management strategy for you.
The Role of Rheumatologists in Managing Rheumatoid Arthritis
Rheumatologists are specially trained internal medicine doctors who specifically deal with musculoskeletal, autoimmune and inflammatory diseases. If you’ve recently been diagnosed with RA, then you’ll need to find a reliable rheumatologist to work with to help with managing your disease.
Your rheumatologist will help with diagnosing your condition, working to pinpoint the stage of RA that you are in. They will then craft a unique treatment plan for you to help with managing symptoms and delaying disease progression.
How We Can Help Manage Rheumatoid Arthritis
The highly skilled rheumatologists at UCF Health Faculty Physician Practice are here to help you if you are living with rheumatoid arthritis. Our providers are experienced in diagnosing, treating and managing the care of individuals with inflammatory conditions like RA. Work with one of them to get a unique plan and a personalized approach to managing your disease.
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Sources
https://www.niams.nih.gov/health-topics/rheumatoid-arthritis/diagnosis-treatment-and-steps-to-take