Rheumatoid arthritis (RA) is a chronic and progressive disease. Understanding its severity is an important factor in helping you and your doctor evaluate whether treatments are working, what treatments to consider next, and how to prevent progression and damage in the future.

The Rheumatoid Arthritis Severity Scale (RASS) was designed to help doctors determine disease activity, as well as functional impairment and physical damage caused by RA.

Different doctors use different assessments to measure disease activity. Besides the RASS, other measurement methods exist. They include the Disease Activity Score-28 (DAS28), Clinical Disease Activity Index (CDAI), and Routine Assessment of Patient Index Data (RAPID3).

In recent years, these assessments have generally replaced the RASS.

The CDAI and RAPID3 tend to be the methods doctors prefer, due to the short amount of time it requires to make assessments, according to research from 2010.

RA causes the lining cells of your joints to become inflamed, which results in swelling, stiffness, and pain. This inflammation involves the affected joints and the surrounding tissues, including tendon sheaths.

RA can sometimes be difficult to diagnose. This is because joint pain and fatigue are not specific to RA, which means they may occur with other health conditions as well.

To diagnose RA, doctors rely on:

  • your medical history
  • a physical examination
  • blood tests
  • X-rays of the hands and feet

Your doctor may refer you to a specialist, called a rheumatologist, to confirm the diagnosis. Anyone with persistent joint pain and swelling without a diagnosis should get a referral to a rheumatologist.

After diagnosis, a healthcare professional should monitor and track the level and progression of RA.

Prior to RASS, doctors combined results from a physical examination, factors reported by the person with RA, such as pain level, and inflammatory blood markers to estimate RA severity.

Another measurement, the Health Assessment Questionnaire (HAQ), has patients rate their own level of pain. Because everyone has a different threshold for pain, such assessment models can be inaccurate.

Experts continue to develop different methods of tracking RA activity and progression over time. With the current understanding of RA and inflammation, there are effective methods for assessing RA activity and severity.

It’s important to know what type of RA you have to get an accurate assessment of disease activity. There are three types of RA:

  • Seropositive RA: In this type, you test positive for cyclic citrullinated peptide (CCP) antibodies (CCP) and rheumatoid factor (RF).
  • Seronegative RA: In this type, you test negative for CCP and RF.
  • Juvenile RA: Also referred to as juvenile idiopathic arthritis, this affects children ages 16 or under.

The RASS measures three areas:

  • disease activity
  • functional impairment
  • physical damage

All three areas are assessed using a range of 1 to 100. A score of 1 means there’s no evidence of the condition, whereas 100 means the maximum level of progression.

Doctors look for disease activity, such as joint swelling, during a physical exam. They will also check for functional impairment with range-of-motion exercises. The physical damage component of the RASS looks at how much permanent damage RA has caused.

The Disease Activity Score (DAS) determines whether RA is in remission or whether there is low, moderate, or severe disease activity. This is perhaps the most important of the three scores for you to be familiar with.

Knowing your disease activity score will help you and your doctor assess whether treatments are working or if they need to be changed.

Following the DAS, the RASS looks at signals of functional impairment (SOFI).

Your doctor determines SOFI by looking at how far and how well you’re able to move your hands, arms (upper SOFI), and legs (lower SOFI). Your doctor will also look at how quickly you can walk a certain distance, either with or without assistive devices like a cane or walker.

The final part of the RASS assessment looks at how much damage the disease has caused. This step is completed with an X-ray or other imaging tools, such as an MRI or a CT scan.

For the physical damage component, your doctor will look for scarring and destruction or deformity of the joints affected by RA and of the bones around them.

Why is my rheumatoid factor over 100?

Your doctor may order a test to measure the rheumatoid factor in your blood. About 80% of people with RA have rheumatoid factor in their blood.

A rheumatoid factor level over 100 is strongly associated with autoimmune diseases like RA. To compare, typical findings are less than 60 u/ml.

In addition to RA, a high rheumatoid factor can also point to cancer, chronic infections, Sjögren’s disease, bacterial endocarditis, or other autoimmune disorders.

What are the 4 stages of rheumatoid arthritis?

RA consists of four stages, each with specific symptoms and treatment goals. Stage 1 is considered early stage RA and includes inflammation inside the joint, leading to swelling of the tissues. You may notice joint stiffness, swelling, or pain.

Stage 2, or moderate stage RA, is characterized by inflammation in the synovium that causes damage to the joint cartilage. This may result in pain, loss of mobility, and range of motion in the affected joint.

Stage 3 is considered severe RA because the damage extends to the bones. You may experience increased joint pain and swelling since the cushion between the bones is gone. Stage four is end stage RA. The joints no longer work because they are fused.

Is rheumatoid arthritis considered severe?

Yes, RA can be severe. That’s because it is a chronic autoimmune disease that progresses as you age. Stage 3 RA is considered severe because the damage extends from the cartilage to the bones, causing increased pain, swelling, mobility loss, and deformity.

If left untreated, RA can reach stage 4, which is considered end stage RA. At this stage, the bones become fused, and the joints stop working.

How is severe rheumatoid arthritis pain treated?

Your doctor may recommend a combination of medication and self-management strategies for treating severe RA pain. While there is no cure for RA, medications can help, according to the Centers for Disease Control and Prevention (CDC).

Medications that slow the progression of RA include disease-modifying antirheumatic drugs (DMARDs), biologic response modifiers or biologic agents, and Janus kinase inhibitors (JAK). These drugs help reduce symptoms while preventing joint damage and disability.

In addition, your treatment plan may also include pain relieving options like nonsteroidal anti-inflammatory drugs (NSAIDs), COX-2 inhibitors, and corticosteroids.

Self-management strategies may relieve pain and improve your quality of life. This may include:

  • physical therapy
  • occupational therapy
  • dietary modifications
  • RA-specific supplements
  • rest
  • massage
  • yoga
  • acupuncture
  • tai chi
  • meditation
  • chiropractic care

Diagnosing RA may not be easy because symptoms can be similar to those of many other conditions.

Once the diagnosis is made, the severity of the disease needs to be determined in order to choose optimal treatment. An ongoing understanding of disease activity is critical to your health and well-being.

The RASS will help your doctor pinpoint the severity of your disease and the effectiveness of treatment.

Check out Healthline’s RA Break It Down Video for an overview of the condition.