Rheumatoid arthritis is a chronic condition. A person’s outlook, or prognosis, depends on many factors, including age, disease progression, any complications, and lifestyle factors.

Share on Pinterest
Westend61/Getty Images

Rheumatoid arthritis (RA) is a common form of arthritis that affects more than 1.3 million people in the United States alone. It can develop in anyone, but it is more common in females than in males and is most likely to present in people aged 25–45 years. When it develops after the age of 65 years, doctors refer to it as late-onset RA.

Key facts on rheumatoid arthritis

  • RA is an autoimmune disease in which the immune system mistakenly attacks healthy tissue in the joints.
  • RA causes inflammation, pain, swelling, stiffness, and reduced joint mobility.
  • People usually experience the symptoms of RA in multiple joints on both sides of the body symmetrically.
  • The symptoms tend to occur in cycles, so people have flare-ups that alternate with periods of remission.
  • Over time, RA can lead to permanent joint damage.

RA is a chronic condition for which there is currently no cure. However, treatment can slow down the progression of the disease. It can also help reduce pain, make symptoms manageable, and prevent joint damage.

In this article, we look at RA in more detail, including the stages of progression and the factors that can influence it. We also discuss the outlook for people with RA and provide tips on how to improve the quality of life with this condition.

It is difficult to predict the exact effect that RA will have on a person’s life expectancy because the course of the disease differs significantly among individuals.

However, one 2015 study showed that people with RA might have a 54% higher risk of mortality compared with people who do not have the condition.

Nevertheless, with the right treatment, many people can live past the age of 80 or even 90 years while experiencing relatively mild symptoms and only minor limitations on day-to-day life.

Once clinical symptoms of RA have presented, they may progress in stages. This is known as progressive rheumatoid arthritis.

Stages of rheumatoid arthritis

There are four stages of RA:

StageSymptoms
Early stagejoint pain, stiffness, swelling, tenderness
Moderate stageinflammation begins to damage the cartilage of the joint bones, reduced mobility and range of motion
Severe stagefurther increase in impact on mobility and motion, development of joint deformities, formation of rheumatoid nodules
End stagesymptoms become much more chronic and severe, possible inability to manage day-to-day tasks, need of assistive devices

Learn more about the four stages of rheumatoid arthritis.

How do I know if I have progressive rheumatoid arthritis?

Generally, signs that a person’s RA is getting worse include:

  • worsening joint pain and swelling
  • more persistent symptoms during flare-ups
  • an increase in the frequency of flare-ups
  • permanent joint damage
  • inflammation spreading to new joints
  • an increasingly restricted range of motion in affected joints
  • decreased mobility
  • treatment having less effect than it did initially
  • development of rheumatoid nodules

If a person is experiencing any of these changes, they may wish to see a doctor for a reevaluation.

Other systemic symptoms

RA can also cause widespread complications throughout the body, not just in the joints. These complications can contribute significantly to a person’s outlook. Some people may also develop systemic symptoms.

The systemic symptoms of RA include:

It is also possible for people with RA to experience complications, including:

These complications are relatively uncommon, but they occur more often in advanced forms of RA. For this reason, people with advanced RA have a significantly lower life expectancy than those whose RA is less active.

Can a test determine the stage of RA?

Blood tests can show a person’s levels of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs). Knowing these levels can help a doctor determine the approximate stage of a person’s RA.

However, the presence of these proteins in a person’s blood is not a definitive sign. Although having ACPAs in the blood will be indicative of RA in most cases, RF can also indicate other conditions, such as Sjögren’s disease or hepatitis.

Doctors also need to look at the symptoms that a person is experiencing to determine whether they have RA. They will also evaluate the level of disease impact based on other testing, such as an MRI scan, ultrasonography, or an X-ray of the joints.

Learn more about diagnosing rheumatoid arthritis.

Although the outlook for people with RA is difficult to predict, several factors can have an influence. They include:

Smoking

Smoking tobacco can adversely affect the progression of RA, and research has shown that it is a significant risk factor for the development of this disease, too. Exposure to secondhand smoke during childhood is also associated with RA.

Smoking causes further inflammation, which can worsen the progression of RA. It also increases the risk of complications, such as respiratory conditions and heart disease.

Early detection

As with many conditions, an early diagnosis of RA can lead to a significant difference in a person’s outlook.

The early stages of the condition tend to involve less inflammation, which is easier to control with anti-inflammatory drugs. Receiving appropriate treatment at this stage can prevent permanent joint damage and minimize the impact of RA on quality of life.

Later diagnosis carries the risk of inflammation already being chronic, which can be difficult to treat. There is also an increased risk of permanent joint damage.

Age

RA usually presents between the ages of 25 and 45 years, but it can affect people of any age.

When the onset of RA occurs at a younger age, there is more time for it to progress. Consequently, it may cause more severe symptoms over time and is more likely to lead to complications.

Obesity

In people with excess body weight, the body stores fat. Fatty tissue releases inflammatory cytokines, which are the same proteins that the joint tissue produces in RA.

For this reason, obesity can exacerbate the symptoms of RA. Maintaining a moderate weight may help reduce flare-ups.

Treatment

Continuing advances in RA treatment mean that the outlook for people with RA is better than ever before. Many people can live a healthy, active life with RA.

For example, disease-modifying antirheumatic drugs (DMARDs) have become an effective and widely available medication for people with RA. These drugs work by suppressing the immune system and minimizing the damage that it does to joint tissue.

RA is a lifelong condition, meaning that ongoing treatment and monitoring are necessary to limit its effects on the body. Doctors may recommend getting regular blood tests and scans to detect any signs of disease progression or complications.

Where possible, regular sessions with a physical therapist can help keep the joints and surrounding tissues healthy.

Learn more about treatments for rheumatoid arthritis.

People with RA can improve their outlook and slow down the progression of the condition by adopting certain lifestyle practices and actively managing the disease.

Doing this may involve:

  • exercising regularly
  • eating an anti-inflammatory diet
  • using equipment, such as straps, to support affected joints when necessary
  • reaching or maintaining a moderate weight
  • avoiding high intensity sports or other activities that put excessive pressure on affected joints
  • adhering to any treatments that a doctor advises, even when symptoms have not flared up
  • quitting smoking, if relevant

Learn more about natural remedies for rheumatoid arthritis.

Below, we answer a couple of commonly asked questions about disease progression in RA.

How fast does RA progress?

RA can progress differently for each person, with the rate varying among individuals. For example, research has shown that for some people who already have RA, symptoms may not present for at least a decade. However, about 40% of people who receive a diagnosis of RA will experience some type of disability within 10 years of receiving their diagnosis.

Is remission possible?

It is possible for a person’s disease to go into remission. This is most likely when a person gets an early diagnosis and receives prompt and aggressive treatment. Doctors consider RA to be in remission if:

  • swelling and tenderness affect a maximum of one joint
  • a blood test shows little or no inflammation
  • an assessment reveals arthritis activity to be 1 or less on a scale of 0–10

It is difficult to predict the course of RA, and the outlook for people with the condition varies significantly. When RA progresses, it typically goes through four stages.

Factors affecting a person’s outlook include age, disease progression, and lifestyle factors, such as smoking and obesity.

However, due to advances in medications and other treatments, the outlook for people with RA is better than ever before, and many people can live for a long time with the condition.