Key takeaways

  • Rheumatoid arthritis (RA) can progress through four stages, from early inflammation to severe joint damage.
  • Signs your RA is progressing can include increased pain and swelling, persistent fatigue, and more frequent flares.
  • Treatment success and disease progression vary by individual. Factors affecting progression include family history, age at diagnosis, stage at diagnosis, presence of certain antibodies, and whether you smoke.

There’s no exact timeline for the progression of rheumatoid arthritis (RA). Without effective treatment, the condition tends to worsen over time, progressing through specific stages.

But many new treatments have been effective at slowing RA disease progression. If your treatment slows the progression of RA, this can help you manage the disease effectively and take care of your health.

As RA progresses, the body changes. Some changes you can see and feel, while others you cannot. Each stage of RA comes with different treatment goals.

Stage 1

Stage 1 is the early stage of RA. Many people may only feel stiffness in small joints, such as the hands, feet, and knees, in the early hours of the morning.

You may experience joint pain independent of the swelling associated with RA. There may be only one affected joint with swelling, instead of the symmetrical presentation typical of RA.

Because symptoms are not obvious during this stage, people who develop RA may not be aware of it initially. Changes will not show up on X-rays, but an ultrasound may show fluid or inflammation in an affected joint.

Blood tests also may not show inflammation markers, but antibodies can be present in the blood years before symptoms start developing.

It is ideal to see a rheumatologist at this point, but doctors may find it difficult to diagnose it at this stage.

Stage 2

Stage 2 is moderate-stage RA. In this stage, the body has made antibodies, and your joints can start to swell.

At this stage, inflammation may start to spread to other organs, such as the:

  • lungs
  • eyes
  • heart
  • skin

Additionally, you may notice lumps on the elbows. These are called rheumatoid nodules.

At this stage, a diagnosis is easier to make and can be seen on an X-ray. If an X-ray is still normal, an MRI could show more. However, in many cases, RA can progress to this point before being diagnosed.

Moreover, some people may have seronegative RA. In this instance, blood tests won’t show antibodies.

Stage 3

Once RA progresses to stage 3, experts consider it severe. At this point, blood tests and imaging are not needed, as the symptoms are visible.

The bones can experience damage (erosion), and some changes in formation may occur. Examples, which may be permanent, include twisted fingers and thickened knuckles. These joints can press on nerves and cause further pain.

Stage 4

At stage 4, there’s no longer inflammation in the joint. This is end-stage RA, when joints no longer work as they should. The joints may experience destruction, and the bones may fuse (ankylosis).

Progression through all four stages can take many years, and some people don’t progress through all stages. Fused bones, or ankylosis, for example, occur in only 0.3% to 1.5% of all individuals with RA.

Some signs that your RA is progressing can include:

  • more joint pain and stiffness
  • persistent fatigue
  • visible swelling and tenderness in joints
  • decreased range of motion
  • symmetrical pain
  • more frequent flares
  • experiencing difficulty with daily activities
  • rheumatoid nodules
  • numbness or tingling in the fingers

By considering these factors, your doctor can help you better understand how your condition is progressing.

However, keep in mind that it’s impossible to predict exactly how RA will progress over time in any person. Even if you have family members with RA, your condition may progress differently from theirs.

When treating RA, your doctor will consider different medication options and recommend a treatment plan for you.

Your treatment plan will depend on:

  • the stage of RA
  • your symptom severity and degree of inflammation
  • how long you’ve been living with RA
  • whether you have other medical conditions, such as heart disease

Common treatments for RA perform different roles:

  • Nonsteroidal anti-inflammatory drugs and steroids can reduce inflammation.
  • Disease-modifying antirheumatic drugs can help protect joint tissue by suppressing your body’s immune and inflammatory responses, which slows RA progression.
  • Biologic drugs work specifically on the immune system to change the body’s inflammatory response.
  • Surgery may be an option in later stages of RA.

Lifestyle is another aspect of managing RA. Your doctor may recommend certain lifestyle choices to complement your treatment plan, including:

RA is a progressive disease, but it doesn’t progress the same way in all people.

Treatment options and lifestyle approaches can help you manage RA symptoms and slow or even prevent disease progression.

Your doctor will develop a personalized plan for you based on your symptoms and other factors.