Rheumatoid arthritis (RA) affects different people in different ways. It can be mild, moderate, or severe, and symptoms vary from person to person.
There’s no exact timeline for the progression of RA. Without effective treatment, the condition tends to worsen over time, progressing through specific stages.
Many new treatments have been successful at slowing RA disease progression. If your treatment slows the progression of RA, you’ll have more time to focus on managing the condition effectively and taking care of your health.
As RA progresses, the body changes. Some changes you can see and feel, while others you cannot. Each stage of RA comes with different treatment goals.
Stage 1 is early stage RA. Many people feel joint pain, stiffness, or swelling. During stage 1, there’s inflammation inside the joint. The tissue in the joint swells up. There’s no damage to the bones, but the joint lining, called the synovium, is inflamed.
Stage 2 is moderate-stage RA. In this stage, the synovium’s inflammation causes damage to the joint cartilage. Cartilage is tissue that covers the end of bones at the site of joints.
When cartilage is damaged, people may experience pain and loss of mobility. Range of motion in the joints may become limited.
Once RA has progressed to stage 3, it’s considered severe. At this point, damage extends not only to the cartilage but also to the bones themselves. Since the cushion between bones is worn away, they’ll rub together.
There may be more pain and swelling. Some people may experience muscle weakness and more mobility loss. The bone can be damaged (erosion), and some deformity may occur.
At stage 4, there’s no longer inflammation in the joint. This is end-stage RA, when joints no longer work.
In end-stage RA, people may still experience pain, swelling, stiffness, and mobility loss. There may be reduced muscle strength. The joints may become destroyed, and the bones become fused together (ankylosis).
Progression through all four stages can take many years, and some people don’t progress through all stages within their lifetime.
Some people have periods of no RA activity. In some cases, this may mean that RA has gone into remission.
Most people with RA experience a gradual worsening of symptoms. There may be periods of relief, where RA is more manageable. At other times, RA symptoms may flare up and be more intense.
How your condition progresses depends on many factors, including:
- family history of RA
- age at diagnosis
- stage of RA at diagnosis
- any disease triggers that are specific to you
- the presence of certain antibodies in your blood
By considering these factors, your doctor can help you better understand how your condition is progressing.
However, keep in mind that it’s impossible to predict exactly how RA will progress over time in any individual person. Even if you have family members with RA, your condition may progress differently from theirs.
The Johns Hopkins Arthritis Center notes that the usual course of RA progression for most people includes flare-ups of high disease activity. Over time, those flare-ups become lengthier and more challenging.
Another common pattern occurs when people experience strong attacks in the early stages of RA, followed by periods with minimal disease activity.
In general, it means that RA disease activity stops. Patients who do not demonstrate the disease markers anti-cyclic citrullinated peptide (anti-CCP) antibody and rheumatoid factor have a greater chance of achieving remission.
When it comes to treating RA, your doctor will consider different medication options and recommend a treatment plan for you.
Your treatment plan will depend on:
- the stage of RA
- the severity of your symptoms and degree of inflammation
- how long you’ve been living with RA
Different types of common medication for RA perform different roles. Some examples include:
- NSAIDs and steroids reduce inflammation.
- Disease-modifying antirheumatic drugs (DMARDs) help save joint tissue by slowing the increase in RA progression by suppressing your body’s immune and inflammatory responses.
- Biologic drugs work specifically on the immune system to change the body’s inflammatory response.
- Surgery may be an option in later stages of RA.
The goal of surgery may be to:
- improve day-to-day functioning
- reduce pain, or
- repair damage caused by RA
- remove the synovium or nodules
- repair tendons
- fuse joints together, or
- replace a joint entirely
Living a healthy lifestyle is another aspect of managing RA. Your doctor may recommend certain lifestyle choices to complement your treatment plan:
- Exercise, especially exercise that does not put too much pressure on joints, can help improve muscle strength.
- Keeping stress in check and maintaining a healthy weight can make it easier to manage RA symptoms at all stages.
- It’s also important that if you smoke, consider stopping, since it can worsen the symptoms of RA.
Remission in RA is indicated by periods of little to no disease activity, and sometimes there are no RA-related antibodies found in blood tests. If this period lasts for more than a few months, it can be considered sustained remission.
The frequency of sustained remission in RA has been low, but it’s increasing over time. Current rates of remission range from 10 to 60 percent or more.
Sustained remission, and especially medication-free remission, include better outcomes for day-to-day function and survival.
Currently, there’s no standard definition of sustained remission. Criteria are generally used to determine remission in clinical trials include:
- fewer than one swollen or tender joints
- scored on a 0–10 scale, related arthritis activity is 1 or less, self-reported by the person living with RA
- little or no increase in levels of C-reactive protein, a marker of inflammation
A combination of early diagnosis and targeted treatment gives you the best chance for sustained remission. Once remission factors are achieved, your doctor will work with you to determine if and when a reduction in medication is recommended.
RA is a progressive disease, but it doesn’t progress the same way in all people.
Treatment options and lifestyle approaches can help you manage RA symptoms and slow or even prevent disease progression.
Based on your symptoms and other factors, your doctor will develop a personalized plan for you.