Rheumatoid arthritis stages of progression

what are the 4 stages of rheumatoid arthritis

Rheumatoid Arthritis

We should know what are the 4 stages of rheumatoid arthritis. Because rheumatoid arthritis is the most common persistent inflammatory arthritis, occurring throughout the world and in all ethnic group. The prevalence is lowest in black Africans and Chinese and highest in Indians. It is more common in female, with a female to male ratio of 3:1. The most clinical course is prolonged with intermittent flaring up and remission. A person with rheumatoid arthritis has an increased risk of cardiovascular disease and that’s why the mortality rate in rheumatoid arthritis is high. With severe disease, there is a reduction in expected lifespan by 8 to 15 years. Like osteoarthritis.

 

There are phases of relief and progression of the disease. Factors that associated with poorer prognosis are

  • Disability at presentation
  • Female gender 
  • Involvement of joints of feet and hands.
  • Damages showing in x rays
  • Smoking

Rheumatoid arthritis will improve as more effective treatments regimes are introduced in patients with early disease. In former year’s round, 25℅ of patients required a large joint replacement but rates are now falling probably due to more aggressive and effective medical therapy.

 

There is no exact time limit for the progression of rheumatoid arthritis. But there are some factors that affect the progression of the disease.

  • Family history
  • Smoking
  • Some specific antibodies that may present in your blood
  • Age at the disease is diagnosed 
  • The stage when the disease is diagnosed.
  • Any associate conditions

As it is a disease of the long run, treatment should be focused on blocking the disease progression and then you will have the time for lifestyle modification and improve your general health. In today’s discussion will explain what are the 4 stages of rheumatoid arthritis.

What are the 4 stages of rheumatoid arthritis?

Stage 1(Early stage):

There is an early manifestation of rheumatoid arthritis in this stage. Sometimes our bodies immune system recognizes bodies own cells as foreign bodies and attacks. This condition is called autoimmunity. These antibodies may present for many years in your blood before showing any symptoms. The radiological and clinical manifestation may be inconclusive. In this stage, the patient can not found any rheumatoid arthritis symptoms. There may be some joint swelling, pain, stiffness in large or small joints of hands, feet, knees etc.

Stiffness tends to get better after some walking or light exercises. The stiffness and pain are more prominent in the morning and improve as time passes. This criterion of pain and stiffness helps to differentiate it from osteoarthritis in which the pain is of mechanical type. The mechanical pain does not go away with time but increased in intensity. In this stage, there is no damage in your bone and cartilage(covering of bones). It also affects synovial membranes which are the covering of joints. There is symmetrical swelling of joints of hands and feet. These and other joints are tender on pressure when actively inflamed and have stress pain on passive movement. Reddening of the skin over the joint is unusual. So we have to know what are the 4 stages of rheumatoid arthritis

Treatment: In this stage controlling can help to halt the progression of the disease.DMARD disease-modifying anti-rheumatic drugs are very helpful. Methotrexate is the most common antirheumatic drug. Though it is a chemotherapeutic drug which is used to treat cancer. But it helps to treat rheumatoid arthritis also. Excess weight can put an extra effect on the affected joint. So losing weight is a good option to prevent progression. Smoking is another risk factor which slows down the effect of treatment and helps to progress the disease also. So quitting smoking is mandatory.

Stage 2(Moderate stage):

In this stage, antibodies tend to increase and there are more severe joint swelling and pain. The disease affects the covering of your bone and gets serious. Lungs, eye, heart, skin may also affect in this stage. The rheumatoid nodule is a characteristic sign of this stage.

The nodule starts to grow in around the affected joint space. It consists of a central area of fibrinoid material surrounded by phagocytic cells. The similar granulomatous lesion may occur in the pleura, lung, covering of the heart, and sclera the white portion of your eyes. In this stage, blood results may be inconclusive but there is a more prominent radiological picture. The plain x rays of the affected joints may show moth-eaten, the erosive surface of bones.

Treatment: Steroid injection is helpful in this stage along with DMARDs.Physical exercise should be suggested because reduced joint mobility can cause muscle wasting. But it can cause pain. So pain is to be managed before starting exercise. Physiotherapy is also suggested. Aerobic exercise can help to prevent muscle weakness to a certain extent.

 

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Stage 3(Severe stage):

The imaging and blood tests are no longer required in this stage because there are more visible and obvious clinical signs of joint involvement. Characteristic deformities may develop with uncontrolled disease. The joints are bent and look like a swan neck.

The thumb looks like letter Z which is called Z deformity of the thumb. Displacement of the joint of hand is common and may cause rupture of associated tendons. Triggering fingers may also originate from the displacement of small joints of the toe. These deformities are less common these days because more advanced treatment option has emerged.

Treatment: Here treatment is case-specific. Joint damage and inflammation happen concurrently and it difficult to distinguish between them. Both the condition cause pain.

Here surgery is an important modality of treatment. An orthopaedic surgeon can make a decision to perform joint replacement surgery or tendon reconstruction if needed.

Psychological support from a professional psychiatrist is also helpful to cope with chronic pain and increase the quality of life. To find out the best modality of treatment the patient should be in close contact with his physician.

 

Stage 4(Final Stage):

It is the final stage and recovery from it is unlikely. All the joints are fused and no joints remaining at all. But the good news is with advanced diagnostic and treatment procedure, this stage is less likely to arise.

Treatment: Although recovery from this stage is unlikely physicians go for palliative treatment. It includes managing pain with drugs like gabapentin, cyclobenzaprine. Amitriptyline is also beneficial for neurogenic pain. It also uses for muscle relaxation. Antidepressant is also needed to make the patient psychologically competent.

Pain medication is dangerous to the kidneys and liver if it is used for a long time. So the patient might need surgical procedure. 

Exercise is a beneficial and popular non-drug treatment for people suffering from rheumatoid arthritis. It has numerous benefits, including:

 

  • It strengthens bones and muscles
  • Joint replacement can be delayed with daily light exercise.
  • It decreases fatigue,
  • It lowers blood pressure,
  • It improving cholesterol levels and thus prevent obesity
  • It reduces pain
  • It improves general well-being.

Swimming is another great option to exercise your body without intense joint pain. With a heated pool, it is extremely beneficial. It makes you feel great while you swim in a hot tub. It helps to decrease inflammation and reduces swelling. It also helps to lower pain.

Some steps to be followed during swimm are given below:

  • Slowly start your routine and spend a few minutes in a heated pool.
  • Use a kickboard which helps you to adjust to moving in the water.
  • Build a goal of swimming 30 minutes regularly.

Other manifestations:

There are some extra-articular manifestations of rheumatoid disease.

  •    Fever
  • Weightloss
  • Fatigue
  • More prone to infection
  • Muscle wasting
  • Anaemia
  • Enlargement of some organs
  • Dry eye
  • Infection of heart
  • Vasculitis
  • Lung infection
  • Nervoumanifestations
  • Skin pigmentation

Pattern of progression of RA syndrome :

Every patient has a different story, different patter. But some common patterns are observed by the physicians over time. 

The patient may have a long period of remission. In this period he might be symptom-free. Stiffness,  pain, swelling goes away as if there was no problem at all. But it is not necessary that the person is disease-free. This type of manifestation starts suddenly and the person became symptomless for decades. But the sad part is that the person has to face symptoms eventually. It does not go away for good.

There is another condition where the symptoms come and go. There is a symptom-free stage and sudden flare-up happens after that.

People need long term treatment in progressive rheumatoid arthritis. In that case, no remission happens or there is no symptom-free period. This people need psychological support from professionals likewise.

Progressive rheumatoid arthritis happens when advancing through the disease stages. This advancing condition is characterized by more frequent flare-ups of inflammation and intractable chronic pain. Who has progressive rheumatoid arthritis also experiences additional symptoms?

 

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Progressive rheumatoid arthritis needs ann aggressive treatment plan provided by a team of physicians like rheumatologist, physiotherapist and psychiatrist. This plan should be designed specifically for your specific symptoms and course of the disease.

 

What works for some patients may not work for others. Genetic predisposition, environmental factors, familial factors and your response to treatment is the main factor for a cure.

How to know that your disease is progressing:

  1. Diagnosis at an early age is a danger sign. It means that the disease has more time to occur damages.
  2. Chronic pain and flare-up symptoms when you are diagnosed.
  3. If there is rheumatoid nodule present around the affected joint.
  4. If there is a sign of inflammation in your blood test.
  5. If there are x-ray findings when diagnosed is a danger sign 
  6. High level of rheumatoid factor, CRP and ACCP is a sing of progressive disease.

What are the investigations to perform:

Nowadays there are advanced techniques to diagnose rheumatoid arthritis. This helps to diagnose the disease at an early stage. Although it is a progressive disease early detection can halt the illness and helps to improve general wellbeing. Clinical diagnoses are more specific but with some blood test and radiological test, it’s easier to find out the ailment.

It helps you and your team of physicians and specialists to make a plan so that you can have a high-quality life and get treated accordingly.

If your doctors can make a diagnosed in the early stage when symptoms are not that severe your chances of getting cured typically increase drastically. But you have to experience flare-ups. Early diagnosis helps to start treatment early and prevent you from the more messed up situation. It does not guarantee the complete elimination of symptoms.

Most important investigations are:

  1. X rays
  2. Ultrasound
  3. Urinary profiling
  4. C reactive protein
  5. Anti-CCP
  6. Rheumatoid factor
  7. Blood tests
  8. MRI

These are the investigations your doctor will perform after clinical examinations.

When to go to your doctor:

The following are guidelines of when to go to your rheumatologist for rheumatoid arthritis treatment:

 

  • When you first experience symptoms like small or large joint pain, stiffness, difficult move joints.
  • Once in a three month during first few years of diagnosis
  • If you experience progressive rheumatoid arthritis
  • If you have worsening symptoms or new symptoms.

Rheumatoid arthritis in pregnancy:

  • Immunological changes in pregnancy: most patients with RA go into remission during pregnancy.
  • Chemotherapeutic drugs should be stopped before trying to conceive.
  • Paracetamol is the only pain killer that should be used in pregnancy.
  • Corticosteroid should be used to control disease flares
  • The main maternal risks are hypertension, glucose intolerance and osteoporosis.
  • Methotrexate is the DMARD which should be avoided during pregnancy.
  • Mothers who are taking chemotherapeutic drugs should stop breastfeeding.

Take home notes:

Rheumatoid arthritis is an autoimmune and progressive disease. It does not cure but the what are the 4 stages of rheumatoid arthritis condition can be delayed with advanced treatment. So having a strong mentality can help you to fight this disease. Early diagnosis is the key. So do not delay to be examined by a doctor. And treatment should be started as early as possible. If you have a positive attitude you can go through this difficult condition and have a beautiful life. Hope now you can understand what are the 4 stages of rheumatoid arthritis form this article.

FAQ

  1. Is rheumatoid arthritis curable?

Ans:  It is not curable but the progression can be delayed with early detection and advanced treatment.

  1. If it is possible to get pregnant with rheumatoid arthritis?

Ans: Yes it is absolutely possible to get pregnant with this condition but you have to follow some additional guidelines.

  1. If disability occurs in rheumatoid arthritis?

Ans:  Yes. Disability occurs in rheumatoid arthritis if someone does not get proper treatment.

  1. Which foods should be avoided in rheumatoid arthritis diet?

Ans: You should avoid the oily food like Fried Foods and Omega-6 Fatty Acids. And you should also avoid alcohol, gluten, dairy products, refined Carbohydrates and Sugar, salt, Spartans, Msg, etc.

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