In short
Rheumatoid arthritis is often described in four stages based on joint changes on X-ray: early inflammation, cartilage damage, bone erosion and deformity, and joint fusion. With modern treatment started early, many people never reach the later stages, which is why prompt diagnosis matters.
On this page
What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is an autoimmune condition in which the immune system attacks the synovium, the lining of the joints. The lining becomes inflamed and thickened, causing pain, swelling and stiffness. Over time, untreated inflammation can damage cartilage and bone.
The four stages
The stages are based on a classification first described in 1949, using X-ray changes. They’re still used to describe how far joint damage has progressed.
Stage 1: early RA
Inflammation of the joint lining, with pain, swelling and stiffness. X-rays show no damage to the bone, though they may show bone thinning around the joints.
Stage 2: moderate
Inflammation has started to damage cartilage, narrowing the joint space. Movement may become more limited. Some bone erosion may be visible.
Stage 3: severe
Bone erosions are visible, and joints can become deformed, with reduced movement and strength.
Stage 4: end stage
Inflammation may settle, but joints are badly damaged and may fuse. Function is significantly affected.
Sore joints slowing you down?
Talk it through with an Australian doctor online. No referral needed.
Does everyone progress through the stages?
No. The stages describe what can happen when RA isn’t controlled. Treatment has changed dramatically. The aim today is to start effective treatment early, ideally within the first few months, and reach remission or low disease activity. Many people who are treated early never develop significant joint damage.
How RA is diagnosed
Doctors use symptoms, examination and blood tests that look for inflammation and specific antibodies (rheumatoid factor and anti-CCP). Classification criteria from American and European rheumatology groups combine the number of joints involved, antibodies, inflammation markers and how long symptoms have lasted. Some people have RA without these antibodies. See seronegative arthritis.
Treatment
Treatment is usually led by a rheumatologist and involves medicines that calm the immune system, adjusted until the disease is controlled. Exercise, physiotherapy, occupational therapy and stopping smoking all help. Your GP plays a big role in monitoring and general health.
When to see a GP
See a GP promptly for swollen, warm joints, especially in the hands and feet on both sides, or morning stiffness lasting more than an hour. Early referral to a rheumatologist makes a difference.
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388(10055):2023-2038.
- STEINBROCKER O, TRAEGER CH, BATTERMAN RC. Therapeutic criteria in rheumatoid arthritis. J Am Med Assoc. 1949;140(8):659-62.
- Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-81.
- healthdirect. Rheumatoid arthritis.
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.