What Are the 4 Stages of Rheumatoid Arthritis?
Jake Newby
| 4 min read
Jake Newby is a brand journalist for Blue Cross Blue...
Key Takeaways
- Understanding rheumatoid arthritis (RA) stages can make symptoms feel less mysterious — and help you recognize why early treatment matters so much.
- Inflammation builds around the joints during the first stage of RA, but permanent damage doesn’t usually set in during this stage.
- By late-stage RA, a person’s joints usually get worse as severe pain, swelling, stiffness and a loss of mobility continue to set in.
- The goal of rheumatoid arthritis treatment is to achieve the lowest possible level of arthritis disease activity and remission, while minimizing joint damage and enhancing physical function and quality of life.
If you or someone you love has been diagnosed with rheumatoid arthritis (RA), it’s logical to wonder what happens next. RA doesn’t look the same for everyone, but experts often split it into four stages to help explain how the disease can progress over time.
Understanding these stages can make symptoms feel less mysterious — and help you recognize why early treatment matters so much.
What is rheumatoid arthritis?
RA is an autoimmune disease, meaning the immune system mistakenly attacks healthy tissue, specifically the lining of the joints. This can lead to pain, swelling, stiffness and joint damage over time. RA is chronic, but it’s also manageable with treatment.
Early signs and symptoms of RA include:
- Pain, swelling, stiffness and tenderness in more than one joint
- Pain and stiffness in the same joints on both sides of your body, including hands and feet
- Stiffness that is especially noticeable in the morning after getting out of bed or after sitting for long periods
- Fatigue and/or weakness
- Fever
Breaking down the four stages of rheumatoid arthritis
Stage 1, Early Rheumatoid Arthritis: this is where RA often starts. It can be difficult for medical professionals to detect RA in this stage, which is highlighted by the immune system attacking the synovium, which is the thin lining around the joints. Inflammation builds around the joints during this stage, according to the Cleveland Clinic, but permanent damage doesn’t usually set in during stage 1.
Stage 2, Moderate Rheumatoid Arthritis: inflammation becomes more persistent and starts to affect the joint structures themselves during stage 2, as inflammation takes a toll on the tissue that cushions joints, known as cartilage. People often feel pain and reduced mobility as a result.
Stage 3, Severe Rheumatoid Arthritis: stage 3 is typically associated with significant damage caused by inflammation. Cartilage loss continues and bone erosion begin during this stage, as joints weaken or become unstable.
Stage 4, End-Stage Rheumatoid Arthritis: inflammation finally lets up in stage 4, but a person’s joints usually get worse as severe pain, swelling, stiffness and a loss of mobility continue to set in. This stage is preventable with early and consistent care.
How quickly does rheumatoid arthritis spread?
In some people, RA symptoms develop over the course of several years, while others may move through the stages rapidly, especially without treatment. Factors that influence progression include:
- How aggressively it’s treated
- How early RA is diagnosed
- Genetics
- Smoking status
How is rheumatoid arthritis treated?
With modern therapies, many people never reach the later stages, which is a major shift from decades ago. The goal of rheumatoid arthritis treatment is to achieve the lowest possible level of arthritis disease activity and, if possible, remission, while minimizing joint damage and enhancing physical function and quality of life, according to the John Hopkins Arthritis Center.
In the early stages, disease-modifying antirheumatic drugs (DMARDs), nonsteroidal anti-inflammatory drugs (NSAIDs) and targeted therapies are used to stop the disease’s progression. In addition to medication for pain control, gentle exercise, physical and occupational therapy and smoking cessation – if applicable – are recommended as supportive care strategies.
Controlling inflammation is the goal for later-stage RA, which involves a combination of medication, combination therapy and close, regular monitoring for flare or progression. Many patients require lifelong treatment even in remission.
Can RA be stopped or reversed?
While RA can’t be cured, it can be controlled. Many people can live full, active lives with minimal disease activity and long-term remission.
Early treatment, regular follow-ups with a person’s primary care provider (PCP) and care team and lifestyle changes like avoiding smoking and getting appropriate exercise can make a meaningful difference. The four stages of RA are simply a framework experts use to describe possible progression and don’t necessarily apply chronologically for everyone.
The most important thing to remember is that early aggressive treatment can greatly improve long-term outcomes for people with RA, so contact your PCP to discuss new or worsening symptoms.
Photo credit: Getty Images
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