I Never Knew the Stage of My RA. Here’s Why Knowing Might Help You

There are four stages of rheumatoid arthritis: early, moderate, severe, and end stage. It’s not necessary to know which stage you’re in, but it can help your doctor track disease progression and adjust your medication.

Rheumatoid arthritis (RA) is a progressive, chronic autoimmune disease in which your body mistakenly attacks the small joints in your hands, wrists, feet, ankles, and neck.

There are four stages of RA, which depict how your symptoms may change as the disease progresses. While there isn’t a set timeline for how your RA may progress through these stages, you can expect it to get worse over time if it’s not effectively managed and treated.

Treatment can slow the progression of the disease and even lead to sustained remission, a period in which you have no symptoms.

Many people living with RA do not know what stage they are in but have some idea of how severe their symptoms are.

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Stage 1: Early stage RA

This stage marks very early attacks on your body’s healthy tissues. You may experience joint pain, stiffness, and swelling in the small joints of your hands, wrists, feet, ankles, and neck.

At this stage, there is no irreversible damage, but the fluid in your joint lining may be inflamed. Typically, any pain, stiffness, or swelling you experience can be relieved with movement.

Because the symptoms are mild and it’s early in the course of the disease, RA is difficult to diagnose at this point. X-rays may not show changes to your bones or joints, but more sensitive tests such as ultrasound and MRI scans may show early signs of the disease.

If you receive an RA diagnosis at this stage and start appropriate treatment, it’s likely that you’ll enter remission.

Stage 2: Moderate stage RA

Stage 2 is considered moderate stage RA. During this stage, inflammation can also begin to affect the cartilage in your joints. Cartilage is found at the ends of your bones, between your joints, and protects your bones from rubbing together. Inflamed cartilage can result in joint swelling and damage.

You may experience increased pain, loss of mobility, and decreased range of motion in the affected joints. This is the stage when most people really begin to notice symptoms and might get a diagnosis.

Your body starts to create antibodies during this stage. But because the process is just beginning, lab tests for these antibodies, which are called rheumatoid factors, might still be negative.

Some people with RA may have negative results from these blood tests throughout all stages. This is known as seronegative RA. But these tests aren’t the only option. Your doctor can use other physical tests to determine a diagnosis and a possible stage.

Stage 3: Severe stage RA

Stage 3 is considered severe stage RA. At this stage, there may be extensive damage to any affected joints.

You may have significant pain because the cartilage in the affected joints might have worn away, resulting in bone-on-bone contact.

This stage may also involve other complications, including trapped nerves (such as in carpal tunnel syndrome) or tendons catching (which can result in, for example, trigger finger).

You may feel grinding, stiffness, and even less range of motion during this stage. You may also feel muscle pain and fatigue due to the systemic (total-body) impact of the inflammation and damage.

Stage 4: End stage RA

Stage 4 is often called final stage or end stage RA.

At this point, inflammation stops, but damage can continue. Affected joints may no longer function and may be fused or permanently stuck in one position. Because of this permanence, this stage is sometimes referred to as end stage.

You’ll continue to experience pain, swelling, stiffness, and limited or no mobility at this stage. You may also have severe muscle pain and fatigue due to the permanent damage.

Stage 4 RA is not common. For example, bone fusion (also known as ankylosis) is rare, occurring in about 0.8% of people with RA.

I’m a nurse practitioner living with RA, and when I’m working with patients, I often call this stage advanced stage rather than final or end stage. I find that “end stage” sounds quite daunting and hopeless. It’s never too late to treat a condition. There are always options that can help improve pain and quality of life, even in advanced stages of a condition.

How fast does RA progress?

There is no predictable timeline for progression through these stages. It could take months, years, or decades. In some people, RA doesn’t progress at all. You might have symptoms that come and go.

You may have periods without any disease activity, and this is considered clinical remission. Whether there is permanent damage at this point is taken on a case-by-case basis.

It’s often anything but a linear progression. For example, you might receive a diagnosis at a later stage and be able to reduce your symptoms with effective treatment. You might experience flare-ups and find triggers as you live with RA longer.

The biggest factor that can affect how your RA progresses is your treatment. It might involve medications, lifestyle changes, or a combination of the two.

Does the stage of your RA matter?

The goal of RA treatment is treat-to-target, which means managing the disease based on its progression with a goal of remission or low disease activity.

Defining the stages of RA is an objective way to categorize how much your RA has progressed or how much your symptoms might have improved. It’s a useful way for you and your doctor to track symptoms and to evaluate how effective a medication or management plan is.

With that being said, many people living with RA have never been told the stage of their RA. Instead, their doctor may tell them about the severity of their symptoms. Your doctor might not indicate or determine a stage for you.

As with anything involving your health, you can choose how much or how little you want to know. But you also don’t have to know the stage of your RA to take good care of yourself. Depending on what suits your needs and your approach to health, knowing the stage of your RA may be helpful in tracking how your symptoms and condition have changed.

Do treatments differ based on stage?

The stages of RA have similar treatment options, but more severe stages may require urgency in treatment, more medications or combinations of them, and possibly higher doses.

Effective treatment can slow the progression of RA or even halt it (remission) and can help manage symptoms such as pain, stiffness, and fatigue.

Some frequently asked questions

Can you reverse the stages of RA?

Early treatment for RA is key to slowing its progression and even getting into remission, but any joint damage you may already have is not reversible.

In some cases, if you receive a diagnosis early and have effective treatment, you can go back to stage 1 from stage 2. But this can be difficult, and it’s more important to focus on treating your symptoms than on “reversing” RA.

Can you cure RA?

RA is a chronic condition that does not currently have a cure. However, with effective treatment, you might enter remission, meaning that the disease is effectively dormant and the symptoms are kept at bay.

Early, consistent, and sometimes aggressive treatment can make remission more likely than ever before.

The takeaway

There are four stages of RA: early, moderate, severe, and end stage. Each stage has different characteristics, which can help you and your doctor track symptoms and evaluate treatments.

Your RA may progress through these stages. However, for many people, it’s not a simple linear progression. You might not get a diagnosis until a later stage, and you might have symptoms that come and go while you’re trying different medications or lifestyle changes.

The biggest factor that can help slow the progression of your RA through these stages is an effective management plan, which might include medication, lifestyle changes, or a combination of the two.

Appropriately treating RA as early as possible may help you have less pain, fewer symptoms, and less long-term, irreversible damage.

*All quotes were shared with permission.