The sooner you start treatment, the better chance you have of avoiding advanced stages.
Treating rheumatoid arthritis may help you have fewer symptoms and feel a lot better. Still, that’s not the only goal of treatment. There are four stages of rheumatoid arthritis, and starting treatment early can help slow the progression. That way, you may be able to avoid or minimize the more serious joint damage that comes from advanced rheumatoid arthritis.
What are the stages of rheumatoid arthritis?
The four stages of rheumatoid arthritis are known as synovitis, pannus, fibrous ankylosis, and bony ankylosis.
Stage I: Synovitis
During stage I, you may start having mild symptoms, including joint pain and joint stiffness. Most commonly, this affects the hands and fingers, as well as the ankles and knees. The immune system has begun attacking the joint tissue, causing the synovial membrane to swell and become inflamed.
Stage II: Pannus
In stage II of rheumatoid arthritis, the continued inflammation has led to a thinning of the cartilage. Normally, cartilage helps provide some cushion for the bones and makes joint motion more fluid. Without all that cushion, joint pain and stiffness may worsen. This also sets the stage for joint damage. Without the protection of cartilage, the bones may begin to erode at the joint.
Stage III: Fibrous Ankylosis
Ankylosis is a term for when bones start to fuse together at a joint, causing unusual lack of mobility. In stage III, the damaged joint area starts to fuse with a connective fibrous tissue. This will severely limit your range of motion, which may make simple tasks even more difficult. At this point, your joints may start to appear bent and crooked.
Stage IV: Bony Ankylosis
As the name suggests, stage IV is when the bones fuse together with actual bone tissue instead of just a connective fibrous tissue. At this stage, pain actually goes away, but so does the ability to move. The joint is essentially gone, so you can’t bend or flex the area. Once someone has stage IV rheumatoid arthritis, they may have trouble doing the tasks and hobbies that they normally would.
Is it possible to slow the progression of RA?
Thanks to today’s treatment, it’s less common to see people reach the most advanced stage. If you learn your diagnosis early and stick to your prescribed treatment, there’s a good chance that you can manage the condition and minimize progression. It's also important to talk to your doctor if it seems like your current treatment isn't working. That way, you can preserve your joint function, reduce pain and stiffness, and live a more normal life.
Dr. Navarro-Millan is a rheumatologist at the Hospital for Special Surgery.