Everybody’s different when it comes to rheumatoid arthritis (RA). Your symptoms may not be the same as those of a friend or neighbor who has the same disease. How your condition changes over time depends on such things as:
- How advanced your RA was when you learned you had it
- Your age when you were diagnosed
- How “active” your disease is
- Stages of Rheumatoid Arthritis
- There is a pre-RA stage, followed by four stages. Each stage has its own treatment options.
- Pre-RA stage
- The pre-RA stage happens before you have any symptoms or a diagnosis. A mix of genes and environmental factors changes your immune system in ways that put you at risk for RA. Your immune system starts making proteins called autoantibodies. These autoantibodies will eventually attack and damage your joints.
- Stage 1
- In the early stages, your joint lining, or synovium, becomes inflamed. If your doctor orders X-rays, they won’t see any damage in your joints yet. But the tissue around the joint may be swollen, making your joint stiff and painful.
Stage 2
In this moderate stage, inflammation damages your cartilage, the cushiony material that protects the ends of your bones. The joint will be stiff, and you won’t be able to move it as far as you used to. X-rays will show some damage to bones in the joint. The doctor will say you’ve lost range of motion.
Stage 3
This is the severe stage. Inflammation wears away cartilage and damages bones near your joints. Your doctor will see evidence of bone and joint damage on an X-ray. Your joints may become unstable and look deformed. You’ll have pain, stiffness, swelling, and loss of motion.
Stage 4
In end-stage RA, the damage to your joint continues. The joint might stop working. You’ll have more severe pain, swelling, stiffness, and lack of motion. Your muscles may be weak, too. You may need joint replacement surgery to restore movement to the damaged joint.
Treatment Based on RA Stages
Just as your condition changes over time, so will your treatment.
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Early stage. A key focus is to control the inflammation. That’s especially important in the early phase of the disease to prevent joint damage. You may get:
- A low-dose steroid
- A disease-modifying antirheumatic drug (DMARD), such as methotrexate
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, for pain
Quitting smoking and losing any extra weight also can help slow your RA.
Moderate stage. This is when you may have trouble with regular daily activities because of pain. You also may tire more easily. There are several options. Your doctor may have you try combining methotrexate with two other DMARD medications, sulfasalazine and hydroxychloroquine. Another option is a stronger form of DMARDs, called biologic DMARDs, including:
- Adalimumab (Humira)
- Certolizumab pegol (Cimzia)
- Etanercept (Enbrel)
- Golimumab (Simponi)
- Infliximab (Remicade)
Instead of a biologic, your doctor may recommend a JAK inhibitor, such as:
- Baricitinib (Olumiant)
- Tofacitinib (Xeljanz)
- Upadacitinib (Rinvoq)
If a certain joint is particularly inflamed, your doctor may give you steroid shots in that joint. Once your pain is under control, it’s important to exercise to keep ahead of your RA. You also may need physical therapy.
Severe stage. If a tumor necrosis factor (TNF) inhibitor doesn’t improve your symptoms, your doctor may recommend you try a different TNF inhibitor or a different class of biologic. If you don’t respond to one, you may respond to another.
Surgery is a last resort for very severe RA. That includes when your joints are deformed and damaged, limiting your mobility. The three most common surgeries for RA are:
- Joint replacement, in which your surgeon replaces your damaged knee, hip, or other joints with man-made replacement parts
- Joint fusion, where two joints are fused and realigned
- Tendon repair, in which your surgeon fixes damaged tendons to ease pain and restore function
