What are the 4 stages of rheumatoid arthritis?

What are the 4 stages of rheumatoid arthritis?


When we think of arthritis, we mainly think of the joints. But rheumatoid arthritis is more than just hot, stiff and swollen joints–in fact, it can also affect a variety of things, including the skin, eyes, lungs, heart and blood vessels.
Whether yourself or a loved one has been recently diagnosed with rheumatoid arthritis, it’s helpful to know the four stages of the disease in order to better prepare for the future.
In this guide we’ll discuss what rheumatoid arthritis is, the causes and who is more at risk, the four stages of rheumatoid arthritis and some of the treatments available to help you live more comfortably.

What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic, incurable condition that causes pain, swelling and stiffness in the joints, typically in the hands, feet and wrists. There may be times when your symptoms worsen; this is known as a flare-up. These flares can be tricky to predict, but there are treatments that can help, which we’ll discuss in more detail later on in the guide.
We know that rheumatoid arthritis causes joint pain, but you might not be aware of the other symptoms that go along with it. Some of the other signs and symptoms you may experience with rheumatoid arthritis include:

  • A throbbing, aching pain in the joints that worsens after a period of inactivity 
  • Stiffness, for example, you may not be able to fully bend your fingers or form a fist
  • Swelling, warmth or redness around the affected joints
  • Fatigue
  • High temperature
  • Sweating
  • Poor appetite
  • Weight loss
  • Dry eyes, if the eyes are affected
  • Chest pain, if the heart or lungs are affected



What causes it, and who is more at risk?

Rheumatoid arthritis is an autoimmune condition, meaning your immune system isn’t working as it should. Normally, your immune system would only send antibodies to kill bacteria and viruses in order to fight an infection.
However, when you have rheumatoid arthritis, your immune system attacks the surrounding tissue in your joints. This results in a thin layer of cells, known as synovium, coating your joints, causing them to become sore, inflamed and release chemicals that harm nearby bones, cartilage, tendons and ligaments.
If your rheumatoid arthritis goes untreated, these chemicals gradually wear away the joint, causing it to lose its shape and alignment, and eventually, it can destroy the joint completely.
It’s not yet known what triggers your immune system to attack joint tissue. But some theories have been suggested – like an infection being a trigger – but none of these have been proven. 
You may be at an increased risk of developing rheumatoid arthritis depending on:
Genetics: There’s a small amount of evidence that suggests rheumatoid arthritis runs in families, but the risk factors are low as genes are unlikely to play a significant part.
Hormones: The condition is more common in women than it is in men, possibly due to the effects of the hormone oestrogen, but this connection hasn’t been proven.
Smoking: There’s some evidence that suggests smokers have a higher risk of developing rheumatoid arthritis.

The 4 stages of rheumatoid arthritis

As your rheumatoid arthritis progresses, it changes your body, too. There are some changes that you’ll be able to see, and some changes you won’t. As you progress into each stage, the treatment plan will shift to adjust to your specific needs and any challenges you may face.
It can take many years to progress through all four stages, and for some lucky people, they don’t progress through all stages within the course of their lifetime. For some even luckier people, their arthritis can go into remission.


Stage one

In the first stage of rheumatoid arthritis, many people experience joint stiffness, pain and swelling. During stage one, the tissue and lining in the joint will be inflamed, but there isn’t any damage inflicted to the bone yet. 
You should see your GP as early as possible if you’re experiencing symptoms of rheumatoid arthritis in order to get a proper diagnosis and start treatment. It’s usually diagnosed through assessing physical ability, blood tests and joint scans.

Stage two

Stage two is when your rheumatoid arthritis is considered moderate. In this stage, the synovium (the thin layer of cells covering your joints) inflames to the point where it begins to cause damage to the joint cartilage. This cartilage damage may result in pain and a loss of mobility.


Stage three

Stage three is when your rheumatoid arthritis becomes severe. The damage has progressed from the cartilage to the bones themselves, and as the cushion slotted between the bones has been worn away, your bones will rub together.
You may experience more joint inflammation and pain, and some people with rheumatoid arthritis can face muscle weakness and increased mobility loss. The bones have started to erode from rubbing together, and deformity may occur.

Stage four

Stage four is end-stage rheumatoid arthritis, where your joints no longer work. You’ll probably still experience symptoms, from pain and stiffness to swelling and mobility loss. There might be reduced muscle strength, too, and as the joints become destroyed, the bones may fuse together, causing something known as ankylosis.

The treatments for rheumatoid arthritis

Thankfully, there are ways to reduce pain caused by rheumatoid arthritis. There are treatments that can help to reduce inflammation, soothe pain and prevent or slow down joint damage and disability. 
Treating rheumatoid arthritis can involve taking medication, lifestyle changes, physical therapy and surgery. For more information regarding the range of treatments you may be offered, visit the NHS website.

A rheumatoid arthritis diagnosis can be life changing, but that doesn’t mean your life has to completely change. Many people living with rheumatoid arthritis are able to live a healthy, active lifestyle with the help of treatments that can slow down the progression of the disease.
Remember, the four stages of rheumatoid arthritis may sound scary, but a lot of people never reach the later stages within their lifetime, and it can take many years to advance through the different stages. For more information about rheumatoid arthritis, visit the NHS or Versus Arthritis website.

Alexandra Moses - Medical Content Writer
James O'Loan - CEO & Superintendent Pharmacist
James O'Loan , CEO & Superintendent Pharmacist on 14 March 2023
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