Stage : Fibrous Ankylosis
During stage three of RA, the joint tissue will continue to disintegrate. The bones where the joints once were will rub against one another and begin to fuse together. When this occurs, movement becomes less possible and more painful. Thus, symptoms will be quite severe. Not only will movement be extremely limited, but the joints will appear misshapen.
The 4 Stages Of Rheumatoid Arthritis
RA is a progressive disease. That means that if RA is left untreated, symptoms will continue to worsen over time. But while 30 years ago that might have meant a person with rheumatoid arthritis was eventually headed for a wheelchair, today that outcome is increasingly unlikely. Whats changed? The treatments available today can slow or even halt the disease, protecting the health of your joints and the rest of your body. Once appear, the goal of treatment remains the same no matter the stage: get RA into remission or at least make the disease less active.
Early Signs Of Rheumatoid Arthritis
If you seek treatment when you begin to notice the early signs of rheumatoid arthritis, you can prevent its progression and loss of movement in the future. If the disease progresses without intervention, though, RA could permanently damage joints. Early signs of rheumatoid arthritis include mainly joint pain and joint stiffness.
These symptoms usually occur at multiple joints at the same time. RA most commonly affects joints in the hands, knees, and ankles.
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Ways In Which Rheumatoid Arthritis Can Affect Feet
- Hammertoes Changes in the tissues around the toe joints cause an abnormal bending of the toes called hammertoe.
- Bunions Changes in the tissues around joints of the big toe cause it to bend toward the little toe and develop a bony nodule.
- Pes Planus This loosening of the arch joint in the middle of the foot may result in a painful flat foot.
- Hindfoot Valgus The loosening of the joint below the ankle causes the foot to bend outward.
Ra Progression: What Are The Signs Of Rheumatoid Arthritis Progression
If you suspect you have rheumatoid arthritis or have been recently diagnosed with RA, you will likely have lots of questions and be feeling uncertain about what this disease means for your future. What is the normal RA progression? Will my symptoms get worse? How can I manage the disease? Do I have to have a surgery?
These are all frequent questions asked by RA sufferers. The reality though is that each patient will experience a unique progression of this disease. RA progression depends on multiple unpredictable variables. Because it is still unclear exactly what triggers RA, it can be nearly impossible to predict an exact outcome.
Below is some general information about what to expect as well as the different stages of RA including the advanced condition known as progressive rheumatoid arthritis.
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How Is Ra Diagnosed
Doctors that specialize in diagnosing RA and other types of arthritis are called rheumatologists. If your primary care provider suspects you might have RA or another type of arthritis, he or she may refer you to a rheumatologist for testing.
A rheumatologist will diagnose RA based on several tests. These include blood tests, imaging tests such as X-rays and MRIs and a physical examination.
Blood tests search for a protein called rheumatoid factor and antibodies called anticitrullinated protein antibodies . Other tests such as the erythrocyte sedimentation rate test and C-reactive protein test can find high levels of inflammation present in people with RA.
These tests also help doctors distinguish RA from other types of arthritis such as gout, osteoarthritis, lupus and psoriatic arthritis.
How To Know If Your Ra Is Progressing
You will know your joints will tell you, Dr. Bhatt says. The pain will get worse and you could have more swelling. Dr. Lally says that although periods of pain may resolve on their own in early RA, these episodes tend to become more frequent and longer in duration until the classic features of RA persist. In addition, Dr. Bhatt says to pay attention to non-joint symptoms like increased shortness of breath or red, painful eyes, which could be signs the RA is affecting other systems in the body. Let your doctor know if your RA symptoms are changing at all.
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Neck Joints Are Not Spared Ra Joint Pain And Damage
- The Neck Someone with RA can also experience inflammation and pain in the neck. This can cause stiffness, weakness, and loss of motion. If not treated, severe inflammation in the neck can lead to instability of the cervical spine.
- The Throat Although rare, the cricoarytenoid joint near the windpipe may also swell from the disease, affecting breathing.
Four Stages Of Rheumatoid Arthritis
While signs and symptoms of rheumatoid arthritis sometimes come and go and can differ from person to person, there are believed to be four stages of the inflammatory disease – each of which has their own treatment.
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Stage 1
In the early stages of rheumatoid arthritis, the initial inflammation and swelling of the synovial tissue occurs. According to Mayo Clinic, in the early stage, rheumatoid arthritis affects the smaller joints such as your fingers or toes .
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Stage 2
Sometimes referred to as the moderate stage, stage 2 sees the inflammation cause damage to the cartilage. Symptoms such as loss of mobility or decreased joint range of motion may become apparent.
Stage 3
In stage 3, the damage the inflammation has caused spreads to the bone itself – making it clear why this stage is seen as severe. Pain, swelling and deformities may occur.
Stage 4
In the last stage of rheumatoid arthritis, inflammation stops and joints may stop working completely. Common symptoms of rheumatoid arthritis still apply, these include: pain, stiffness and loss of mobility.
If youre at risk of a chronic inflammatory disease, its important to know more about your CRP levels as CRP is known to increase when inflammation is present in the body. Its important to remember that CRP elevations are non-specific but can help in identifying an underlying inflammatory disease.
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Some People Experience Fatigue And Other Flu
Up to a third of patients have more systemic symptoms before or along with joint pain and inflammation. This can include fatigue, muscle pain, mood changes, and low-grade fever. As the digital arthritis community CreakyJoints puts it, “Some patients describe the symptoms of RA as being ‘flu-like’ that general yucky feeling you get when you are on the verge of getting sick.”
Although these symptoms can be an early sign of RA, because they overlap with other illnesses, RA usually isn’t the first thing the doctor considers, especially without joint pain.
Other symptoms many don’t realize can also indicate RA include rashes, easily bruising, itchy and dry eyes, and sharp chest pain brought on my irritation of the costosternal joints, which connect the ribs to the breastbone.
Joint Damage Pain Deformities Loss Of Function: Late
It is important for people with these symptoms to be diagnosed as soon as possible, because if RA isnt diagnosed and treated early the synovial lining can become so inflamed that it damages and erodes the cartilage this makes bone loss more likely.
Moving joints becomes more difficult, and flare-ups can occur with greater frequency. These joint changes are called erosions, and they can lead to deformities of the bone, such as crooked fingers, says Daniel Solomon, MD, MPH, chief of the section of clinical sciences in the division of rheumatology at Brigham and Womens Hospital in Boston. In severe cases, bones may eventually fuse together. All of this further contributes to pain and loss of function.
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Early Diagnosis And Progression
RA can lead to bone erosion and joint destruction over time if left untreated or not well managed. Recognizing and treating early symptoms is essential to stop or slow the progression of the disease.1,2
RA does not progress the same for everyone. The overall course of the disease can vary from person to person, depending on several factors:1
- Number and severity of symptoms
- Presence of inflammatory proteins in the blood
What Types Of Lifestyle Changes Can Help With Rheumatoid Arthritis
Having a lifelong illness like rheumatoid arthritis may make you feel like you dont have much control over your quality of life. While there are aspects of RA that you cant control, there are things you can do to help you feel the best that you can.
Such lifestyle changes include:
Rest
When your joints are inflamed, the risk of injury to your joints and nearby soft tissue structures is high. This is why you need to rest your inflamed joints. But its still important for you to exercise. Maintaining a good range of motion in your joints and good fitness overall are important in coping with RA.
Exercise
Pain and stiffness can slow you down. Some people with rheumatoid arthritis become inactive. But inactivity can lead to a loss of joint motion and loss of muscle strength. These, in turn, decrease joint stability and increase pain and fatigue.
Regular exercise can help prevent and reverse these effects. You might want to start by seeing a physical or occupational therapist for advice about how to exercise safely. Beneficial workouts include:
- Range-of-motion exercises to preserve and restore joint motion.
- Exercises to increase strength.
- Exercises to increase endurance .
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Signs Your Ra Is Progressing
How can you tell your RA is getting worse? There’s no easy way, but some general signs include:
- Flares that are intense or last a long time
- Diagnosis at a young age, which means the disease has more time to become active in your body
- Rheumatoid nodules — bumps under your skin, often around your elbows
- Active inflammation that shows up in tests of joint fluid or blood
- Damage on X-rays when you were diagnosed
- High levels of rheumatoid factor or citrulline antibody in blood tests
When To Seek Treatment
The following are general guidelines of when to seek treatment for your RA progression:
When you first suspect symptoms Regularly during the first few years of diagnosis If you suspect you are experiencing progressive rheumatoid arthritis If you feel your condition is worsening in any way or new symptoms appear
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Early Diagnosis Key For Mitigating Joint Damage
Joint damage is irreversible. Therefore, early diagnosis and treatment are important for controlling RA and halting the inflammation that leads to joint damage.
Although joints tend to be the body structures most affected by RA, it is considered a systemic disease, meaning it can also affect other body parts, including the heart, lungs, skin, and eyes.
How you feel and how RA progresses is dependent on several factors, including:
- How advanced your RA was at the time of diagnosis
- How old you when you were diagnosed
- How active your disease is currently
- The presence of antibodies in your blood: Two types of antibody molecules are present and elevated in people with RArheumatoid factor and anti-citrullinated protein antibody . RF is detectable in up to 80% of people with RA and ACPAs are found in up to 90% of RA patients. Both are known for causing high disease activity.
However, most people with RA will experience a gradual worsening of symptoms. RA progression is demonstrated in patterns over the years.
Stage : Bony Ankylosis
In the final stage of RA, the bones completely fuse together and the joints are no more. With the absence of joints, there is an absence of pain as well. However, as you might expect, the range of motion in affected joints is zero. For affected finger joints, stage four RA can make it extremely difficult to perform simple tasks.
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Is Rheumatoid Arthritis Genetic
It is true that people with specific genes are more likely to develop RA. These genes are called HLA class II genotypes. However, lifestyle factors do play a role. For instance, a person with the genes who smokes or is obese is more at risk than someone with the genes who maintains a healthier lifestyle.
Signs And Symptoms Of Rheumatoid Arthritis
RA usually presents as symmetrical arthritis, which means both hands, both knees, or both wrists, for example, are affected. This is a characteristic feature of RA.
The most common signs of rheumatoid arthritis include:
- Joint pain and tenderness
- Redness and warmth in the joint
- Stiffness and restricted range of motion of the joints
- Joint deformity
- Hard bumps around the joints, present below the skin
- Red, puffy hands
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Patterns Of Rheumatoid Arthritis Progression
Most people with RA see symptoms gradually worsen. There will also be times of relief. Pain can be more manageable during these times. Other times, there can be flare-ups. These are associated with intense pain. Different factors influence RA progression, such as:
- Family history of RA
- Presences of certain antibodies
- The stage of your RA when diagnosed
Keeping these factors in mind can help you understand the condition. And the key is how its progressing. However, there is no way to predict how rheumatoid arthritis will continue. Its even possible for your condition to vary vastly from that of a family member. Therefore, all you can do is best to understand your RA.
One thing research shows are that flare-ups are common. Over time, flare-ups will last longer and be more intense. Its also common to experience strong attacks early on. After these attacks, there are typically periods of minimal rheumatoid arthritis activity, though.
A small percentage of people can fall into remission after 6 months. This means that disease activity has stopped. In fact, these people do not have specific antibodies present.
The Stages Of Rheumatoid Arthritis
by rheumatologyphysio | Jan 28, 2019 | Uncategorized
Intro
This is the second blog of my Rheumatoid Arthritis series that looks to expand upon the article for PhysioFirst which you can read in full here. It has topped 9000 downloads at the time of writing this blog and I am immensely proud of it as a piece of work, it was however hamstrung by a word limit and primary topic being the joint dysfunction component of RA. Check out the intro to RA here prior to reading this one.
This portion will introduce the 3 stages of RA. When I wrote the original article I was only beginning to become aware of the pre-diagnosis stage and I did not have the knowledge to write confidently about it nor did it fit within the remit of the original article. As such here is an outline of the three stages. These will be expanded on in due course in dedicated blog posts.
As usual feedback is gratefully received as are any materials I might be interested in!
PLEASE REMEMBER THIS BLOG IS NOT A REPLACEMENT FOR CLINICAL REASONING, IF YOU ARE UNSURE GET ADVICE
The Stages
There is a suggestion in the literature that there are two stages to a persons experience of Rheumatoid Arthritis , this is more obviously borne out in the clinical guidelines . While these are clearly the same medical condition they are associated with different joint dysfunctions and therefore important nuance in the management of the joints from a Physiotherapy perspective.
Pre-diagnosis
Early RA
Established RA
References
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Can Rheumatoid Arthritis Go Away
No, rheumatoid arthritis doesnt go away. Its a condition youll have for the rest of your life. But you may have periods where you dont notice symptoms. These times of feeling better may come and go.
That said, the damage RA causes in your joints is here to stay. If you dont see a provider for RA treatment, the disease can cause permanent damage to your cartilage and, eventually, your joints. RA can also harm organs like your lung and heart.
A note from Cleveland Clinic
If you have rheumatoid arthritis, you may feel like youre on a lifelong roller coaster of pain and fatigue. Its important to share these feelings and your symptoms with your healthcare provider. Along with X-rays and blood tests, what you say about your quality of life will help inform your treatment. Your healthcare provider will assess your symptoms and recommend the right treatment plan for your needs. Most people can manage rheumatoid arthritis and still do the activities they care about.
Last reviewed by a Cleveland Clinic medical professional on 02/18/2022.
References
The Stages Of Arthritis
Arthritis is a common joint condition that causes inflammation and pain in the joints of the body. Arthritis comes in many forms, as there are more than 100 different types of this joint disease. Because of this, the various types of arthritis follow different stages of progression.
However, most types of arthritis follow a similar progression process. Below, we highlight two of the most common arthritis types: osteoarthritis and rheumatoid arthritis.
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Whats The Age Of Onset For Rheumatoid Arthritis
RA usually starts to develop between the ages of 30 and 60. But anyone can develop rheumatoid arthritis. In children and young adults usually between the ages of 16 and 40 its called young-onset rheumatoid arthritis . In people who develop symptoms after they turn 60, its called later-onset rheumatoid arthritis .
Symptoms And Early Signs
Typically, the first sign of rheumatoid arthritis is stiffness, followed by pain and tenderness in the joints. These symptoms can worsen slowly over weeks or months. Most often, symptoms start in smaller joints such as fingers and toes, and then move to other joints.
The number of joints affected varies, but RA most often attacks five or more joints. It may start as swelling that comes and goes, lasting for a few days or weeks at a time, but it gradually gets worse.
Symptoms may also worsen and occur in intense attacks called flares when triggered by stress, suddenly stopping medications or too much activity, according to National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Common RA symptoms include:
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