There are four distinct stages of rheumatoid arthritis (RA) that can progress over time. Health experts define the four stages as early, moderate, severe, and end stage RA.

Rheumatoid arthritis (RA) is a chronic, systemic autoimmune condition where the body mistakenly attacks healthy joints. Each case of RA is unique, but most people experience four stages of RA as their condition progresses over time.

In this article, we explore symptoms and treatments for the four RA stages.

We also discuss factors and lifestyle changes or habits that may impact how the condition progresses, and when to get medical attention.

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There are four distinct stages of RA that can progress over time, although not everyone experiences them the same way.

Factors such as how well a person and their doctor manage RA, how early doctors diagnose and start to treat it, and several lifestyle or genetic factors also help determine how the condition progresses.

The four stages of RA are:

  • stage 1, or early RA
  • stage 2, or moderate RA
  • stage 3, or severe RA
  • stage 4, or end stage RA

Regardless of the stage, RA symptoms usually impact both sides of the body equally and are often most severe when a person first rises or after they have been immobile for a long period of time.

Ultimately, RA symptoms stem from joint inflammation in a person’s joints, affecting the tissues that line them, called synovial tissues.

Additionally, as RA progresses and symptoms worsen, this chronic inflammation causes joint damage, impacting more joints and resulting in additional complications, such as malfunction of joints and limitation of mobility.

A person can manage all stages of RA using a combination of medications, lifestyle changes or habits, over-the-counter (OTC) drugs, and at-home remedies.

Treatment for RA focuses on:

  • reducing inflammation
  • preventing or reducing joint damage, loss of motion or mobility, and deformity
  • reducing the risk of loss of function
  • maintaining good quality of life
  • managing additional RA complications

People with stage 1 RA, or early RA, often experience joint tissue inflammation that causes:

During early RA, joint damage typically does not occur. For the best possible outcome, a doctor should diagnose and treat early signs of RA within 12 weeks after they develop.

Methotrexate, a chemotherapy medication that alters the immune system response, is typically one of the first-line drugs used to treat a person with an RA diagnosis. A person can take methotrexate in pill or injection form.

Methotrexate and other drugs that change the body’s immune response over time also go by the name of disease-modifying antirheumatic drugs (DMARDs).

Other DMARDs that healthcare professionals commonly use early in the treatment of RA include:

Most people with RA require additional treatments to fully manage their symptoms and slow disease progression. Additional medical interventions to help treat and manage stage 1 RA include:

People with stage 2 RA, or moderate RA, often experience more severe or longer periods of stage 1 symptoms, as well as increasingly frequent or long periods of reduced mobility or range of motion.

In stage 2 RA, synovial inflammation in joints can start to cause damage to the joint cartilage.

After identifying joints that are at risk of destruction, doctors will continue treatment using DMARDs and other prescription or OTC medications. Depending on patients’ response, doctors may add to the medication regimen another class of drugs called biologic response modifiers.

These medications target joint inflammation by blocking the immune protein tumor necrosis factor or the action of immune cells called T cells.

Examples of biologic agents for treating RA include:

People with stage 3 RA, or severe RA, often experience much more severe pain and more frequent joint swelling and associated symptoms than those typical of stage 1 or stage 2. In stage 3 RA, inflammation becomes so severe that it destroys joint bones and cartilage.

Additional symptoms of stage 3 RA include:

  • further decrease in the range of motion and mobility
  • physical joint deformities, such as curved or knobbly hands and toes
  • rheumatoid nodule formation around joints

People with stage 3 RA usually take the same medications that healthcare professionals use to treat earlier stages of the condition.

If other medications are unsuccessful, a person may use another type of DMARD called Janus kinase inhibitors, otherwise known as JAK inhibitors, alongside traditional DMARDs.

In this last stage, called end stage RA, joint tissue inflammation decreases significantly. Also, the condition leaves normal joint function more compromised.

Most people with end stage RA experience the same symptoms as people in the earlier stages of RA, although symptoms of functional capacity tend to be more severe, chronic, and disabling.

Typically, people with end stage RA have tried all medical options that healthcare professionals use to treat other stages of RA.

As a person loses their physical abilities, they usually need to rely on assistive mobility devices to perform daily tasks. People with end stage RA may also receive surgery to regain bodily function and repair joint damage.

Researchers still do not fully understand why RA occurs or what makes it progress.

However, several factors seem to impact the progression of RA, generally worsening the disease. These factors include:

  • stage and severity of RA at diagnosis
  • family history of RA
  • presence of RA-associated antibodies, such as the rheumatoid factor or anti-cyclic citrullinated peptide
  • having overweight or obesity
  • smoking
  • having RA-associated genes called human leukocyte antigen class 2 genotypes

While each case is unique, changing some lifestyle choices or habits may help reduce RA symptoms or prevent them from worsening.

Lifestyle changes that may help people with RA include:

  • eating a balanced, nutritious diet
  • reaching or maintaining a moderate body weight
  • quitting smoking
  • keeping moving by taking the stairs instead of elevators, parking farther from the office or stores, and taking short movement breaks throughout the day
  • doing low impact exercises, such as swimming, biking, or walking for 30 minutes five times per week, for a total of 150 minutes per week
  • resting during RA flare-ups to help reduce inflammation and fatigue in order to preserve energy for essential daily tasks
  • using heating pads or warm water to ease stiff joints and tired muscles
  • using cool packs or ice packs for 20-minute intervals to help reduce inflammation in swollen, painful joints
  • trying OTC topical pain products, such as those that numb the area
  • using topical products that contain medications a person might normally take in pill form, such as NSAIDs
  • trying to manage stress using deep breathing, guided imagery, meditation, or yoga
  • using complementary therapies during periods of remission, such as massage, chiropractic treatments, and acupuncture
  • engaging in enjoyable and rewarding hobbies
  • staying connected to friends and family and asking for help when needed
  • taking certain supplements, in particular omega-3 fish oil, turmeric, and gamma-linolenic acid supplements
  • engaging in self-management education programs to learn coping mechanisms and gain confidence in the ability to help control symptoms

Anyone who thinks they may have RA, are concerned about their risks of developing it, or are experiencing unexplained pain, stiffness, and inflammation anywhere in their body should seek guidance from a doctor as soon as possible.

People should also contact a doctor:

  • as soon as joint pain and stiffness symptoms develop
  • if symptoms are worsening, becoming more frequent, or impacting more parts of the body
  • if the condition is severe, progressing rapidly, or not well-managed

Patients should contact a doctor frequently during the first few years after receiving an RA diagnosis.

RA has four distinct stages with varying degrees of symptom intensity, functional limitations, and possible complications, requiring evaluation for treatment and management options.

Around 10–15% of people with RA experience remission of the condition. Although outcomes depend on individual factors, it is important to diagnose and treat RA early.

Eating healthfully, quitting smoking, and reaching a moderate weight, for example, may also slow the progression of RA. A person should seek medical attention if joint swelling, pain, or stiffness occur frequently or for no reason or if other signs associated with RA develop.