What Are The 4 Stages of Rheumatoid Arthritis

Every person faces joint pain issues in their life. Arthritis is one of the common joint inflammation disorders that is more common in aged people. With the increase in age, the risk of arthritis also increases, but it doesn’t mean that the younger generation is not at risk of arthritis.

So, it is very important to take care of bones and joints. Never ignore your joint pain otherwise it becomes serious joint damage.

Sometimes people have rheumatoid arthritis but due to a lack of knowledge, they can’t understand the problem. As a result, they don’t pay attention to any symptoms or signs of the disease and then their situation becomes worse and leads to disability.

That’s why we come up with this article on what are the 4 stages of rheumatoid arthritis, to help you and give you the necessary information regarding arthritis, more essentially rheumatoid arthritis.

And if you don’t know about the stages of rheumatoid arthritis then scroll down to get to know about what are the 4 stages of Rheumatoid Arthritis1.

Rheumatoid arthritis
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1. What is Arthritis

One of the most common joint injuries is Arthritis. According to the Centers for Disease Control and Prevention, around 58.5 million people in the US have arthritis. But what is this joint problem in actuality?

Arthritis is a disease that occurs due to inflammation in the joint area of bones. Any kind of inflammation or degradation of the joints leads to joint pain.

Arthritis Symptoms

As this disease is related to joints and bones, it is obvious that you will get pain and discomfort in that part of your body.

Here are the following symptoms that you will feel if you have arthritis disease.

  • Swelling
  • Pain
  • Tenderness
  • Stiffness
  • redness

2. Types of Arthritis

Although there are various types of arthritis, the common types of arthritis are those mentioned below.

2.1. Osteoarthritis

This usually occurs due to the increase in age. With age, your bones start losing density, and the cartilage that joins bones degrades.

Due to that reason, you feel pain and difficulty in the movement of your hands and knee joints.

2.2. Psoriatic Arthritis

Just like Psoriasis, it is also linked with skin inflammation. Despite skin inflammation, it also causes joint damage or joint inflammation. Most often, it causes inflammation in the fingertips and toes.

2.3. Gout

A different kind of joint inflammation arises due to the accumulation of uric acid. The main reason behind this is the increase in the level of uric acid. Joints and kidneys are affected by this disorder.

2.4. Rheumatoid Arthritis

This is one of the most severe joint damage. It usually happens in those parts where lots of pressure is exerted like heels and knuckles. RA is a kind of autoimmune disease.

2.5. Juvenile Arthritis

By its name, you will get the idea about this kind of arthritis. It occurs in children and affects their joints. It is also an autoimmune 2disorder, like rheumatoid arthritis.

3. Rheumatoid Arthritis

Rheumatoid arthritis
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The chronic type of arthritis is Rheumatoid Arthritis (RA), in which the inflammation occurs due to the attack on the body’s immune system. As the immune system is involved in the cause of RA, that’s why it is considered an autoimmune disorder.

Mostly, it affects the joints but also affects other parts of the body including skin, lungs, heart, eyes, and mouth.

The chances of the development of rheumatoid arthritis are more in women than in men and it is usually observed in middle-aged people.

It is different from osteoarthritis as in this case, mainly joint pain and swelling occur, and the deformities in bones are the sign of the end-stage or severe stage.

3.1. Symptoms

The most common symptoms of RA are pain in joints or swelling. But at the initial stage, only smaller joints like joints of fingers, and toes are getting affected. As a result, all the pain and swelling occur in that region only.

With RA progression, its symptoms are also spread to other body joints.

The appearance of rheumatoid arthritis signs can vary from person to person. In some people, the symptoms appear very quickly within a few days while in some people it will take up to a week.

3.1.1. Symptoms of RA that Rise at The Early Stage

  • Fatigue
  • Slight fever
  • Joint tenderness
  • Swelling and joint pain
  • Numbness in hands and feet
  • Difficulty in joint movement

3.1.2. Symptoms of RA that Are Shown at The End-Stage

The end stage of RA is marked by the development of more severe symptoms. At this stage, the condition of RA turns into severe RA.

The condition is going to be worse because of the continuous depletion of bones. This stage doesn’t show any more inflammation, but your bones become so weak that you can’t even move your joints.

In severe cases, it turns into a loss of joint movement.

Rheumatoid Arthritis (RA) Signs & Symptoms (& Associated Complications)

3.2. Types of Rheumatoid Arthritis

3.2.1. Juvenile Rheumatoid Arthritis

In children, when the body mistakenly attacks its cells as foreign bodies, Juvenile Rheumatoid Arthritis begins to develop. Juvenile RA is also known as Juvenile idiopathic arthritis.

A child with JRA shows the same symptoms that occur in the case of Rheumatoid Arthritis.

The treatment of JRA is quite similar to the RA treatment. That’s why the same medications are recommended by doctors for patients with RA and JRA.

Along with the medication, proper physical therapy and exercises show quick results.

3.2.2. Seropositive Rheumatoid Arthritis

Out of all the types of RA, this one is the most severe type. This is because it doesn’t only affect the joints but also affects the other body parts including the lungs as well. It is also associated with the development of Rheumatoid nodules.

In this case, some kind of antibodies called rheumatoid factors are present in the blood. Their presence marks the development of seropositive RA.

For the diagnosis of Seropositive Rheumatoid Arthritis, anti-citrullinated protein antibodies play an important role.

3.2.3. Seronegative Rheumatoid Arthritis

Seronegative RA is very rare. The absence of rheumatoid factor and anti-CCP in the blood is marked as a sign of the development of Seronegative Rheumatoid Arthritis. Due to this reason, it is the opposite of seropositive RA.

Rheumatoid arthritis is a kind of progressive disease that becomes worse or more severe with time. That means, if it is not treated on time the condition becomes more complicated.

Although there is no absolute treatment available for RA, some disease-modifying antirheumatic drugs show effective results.

A C-reactive protein test is considered to be best for the diagnosis of RA instead of a blood test.

Check out what are the 4 stages of rheumatoid arthritis that are important to know and also about their treatment. The knowledge of all four stages of rheumatoid arthritis will be going to be more helpful in treating rheumatoid arthritis progression.

4. What Are the 4 Stages of Rheumatoid Arthritis?

What Are the 4 Stages of Rheumatoid Arthritis?

All four stages are arranged in increasing order as per their symptoms and severity. The four stages of RA are synovitis, pannus, fibrous ankylosis, and bony ankylosis.

Each stage of rheumatoid arthritis RA progresses with the development of more pain and damage in joint tissues or joint lining. Hence, it is always better to take precautions at an early stage otherwise it turns into a chronic disease.

As RA progresses, various changes occur in the body mostly near the joints region. Most of the changes in the joint region are different depending on the different stages of RA.

All the symptoms are responsible for the diagnosis of different stages of RA, as a result, it is going to be easy to identify at which stage of RA you are on. Hence, you can easily get treatment for RA.

4.1. RA Stage I: Synovitis

The beginning stage of Rheumatoid arthritis is Synovitis or synovial inflammation. At this early RA stage, slight symptoms will appear.

These symptoms are pain in fingers, hands, knees, and ankles.

The beginning of this stage is associated with the attack of the body’s immune system on the synovial membrane. Due to that reason, the synovial membrane is also affected in this stage.

The synovial membrane envelops the synovial fluid present in between the joints. It has a significant role in keeping joints free from damage or any injury.

As it regulates the synthesis of synovial fluid, which is present inside the joint cavity, this fluid provides nourishment and protection to the joint cartilage by keeping your joints lubricated.

Due to the inflammation and swelling in the synovial membrane, you will feel slight pain and stiffness in joints.

But these symptoms are very mild and confusing that’s why you can’t even imagine that the pain is because of synovitis.

So, never ignore even slight pain and inflammation in joints or muscle regions.

At this stage, only the joint lining gets affected, and bones are free from damage or inflammation. Hence, it would be good to treat RA at this stage.

synovial fluid in joints
Image by creative pic on Unlimphotos

Synovitis Treatment

For its treatment, firstly you have to be sure whether you have synovitis or not as the early signs or symptoms are similar to the symptoms of other diseases.

In this case, visit a rheumatologist, he/she will help to diagnose the first stage of RA. Through MRI or musculoskeletal ultrasound, this can be confirmed.

Once you are diagnosed with synovitis then oral drugs and injections are the best way to treat synovitis. The medication for synovitis includes anti-inflammatory drugs especially DMADs and also steroid injections.

If this treatment does not work, then the last option is to go with Synovectomy3. It is a kind of surgery in which the affected synovium is going to be removed through a surgical treatment.

4.2. RA Stage II: Pannus

The untreated first stage of rheumatoid arthritis reaches the next stage, Pannus. At this stage, continuous inflammation in the synovial membrane and cartilage is going on.

This continuous inflammation in cartilage causes lots of damage to it, and as a result, more pain and difficulty in motion happen.

At this stage, you will feel severe pain, as your cartilage gets damaged. This damage happens because of the continuous inflammation in the synovial tissue.

This results in the uncontrollable growth of synovial tissues and the formation of a clump, known as a Pannus. The development of Pannus 4causes more and more pain and stiffness in joints that are not tolerable.

If the Pannus or extra tissue growth in the joint is left untreated, it becomes a noncancerous tumour. Pannus can easily be detected through imaging tests including MRI5, CT scan, or X-rays.

This stage only comes when rheumatoid arthritis is not treated at the first stage.

Pannus Treatment

The treatment of pannus is completely similar to the way of treating RA. That’s why disease-modifying anti-rheumatoid drugs including leflunomide, methotrexate, or hydroxychloroquine are used to reduce disease activity and the risk of joint deformities.

Corticosteroid drugs or nonsteroidal anti-inflammatory drugs are also used to control RA progression.

This disease begins when the body mistakenly attacks its cells because some biological response modifiers or biological are also very effective in controlling the body’s immune response.

Biological response modifiers are used only when there is no improvement observed through nonsteroidal anti-inflammatory drugs6.

4.3. RA Stage III: Fibrous Ankylosis

The third stage of RA is marked as a severe RA stage, as the pain or stiffness is not limited to joints, but also reaches to bones.

At this stage, the cartilage is completely damaged and now the next target is damaging bone. Due to the weakness and erosion of bones, you can feel so much pain and muscle weakness.

The connective fibrous tissue becomes fused with the damaged joints and affects the joint’s movability.

Fibrous Ankylosis is considered to be acute rheumatoid arthritis, that results in severe joint tissue inflammation.

More importantly, it causes bone deformities, if not treated on time. Even if at this stage, you don’t get treatment, the disease progression leads to the development of bony ankylosis.

The symptoms of this stage are a combination of both the early stages of RA. Other symptoms are curved hands or toes, movement problems, and rheumatoid nodule formation near joints.

Fibrous Ankylosis Treatment

Medications are used to control the beginning stages of this progressive disease and become effective in treating this stage of RA as well.

As this stage is marked by the loss of motion and results in deformities, proper rest should be done by the patient.

The use of steroid drugs along with physical exercise and therapy will be very effective.

4.4. RA Stage IV: Bony Ankylosis

The last stage in this list of what are the 4 stages of rheumatoid arthritis is Bony Ankylosis. The RA symptoms worsen, if not treated at the beginning stage and reach the fourth stage called the end-stage RA.

As its name, at this stage, the bones fuse and cause mobility issues. Although the joint tissue inflammation is stopped, the damage continues.

You experience too many problems in bending and moving your joints or bones. You can’t even able to do your daily routine activities.

Such a condition only happens when your disease progresses continuously with a lack of treatment.

This is going to be a severe stage and only surgical treatments are the option for its treatment.

End-stage RA diagnosis should be done by simply observing mobility and also through X-rays or MRIs.

Bony Ankylosis Treatment

The use of steroid drugs and medications does not show any improvement. Hence, RA surgery will be the best option.

The most common surgical treatments for it are such as arthroplasty and orthognathic surgery. There are some kinds of joint replacement and tendon repair surgeries as well.

Surgical treatment
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5. Risk Factors For Rheumatoid Arthritis

The major reason behind the cause of rheumatoid arthritis is the rheumatoid factor produced by the immune system. RF is a protein mainly found in those persons who are diagnosed with RA.

There are some other risk factors as well that are associated with the development of RA. Without the knowledge of the risk factors of RA, there is no value in knowing about what are the 4 stages of rheumatoid arthritis.

  • Women are at higher risk than men.
  • Although RA occurs only in aged people it is not specific to age.
  • Smoking is responsible for increasing the risk of the development of RA. Various studies have shown that nicotine consumption increases the risk of RA. And also turns worse if you do not quit smoking.
  • Overweight or obese persons are also at higher risk of RA. That’s why a healthy weight is very important.
  • Genetic factors also increase the risk of RA. HLA (Human Leukocyte Antigen) genes are responsible for the development of RA, if you have these genes then you are at high risk of RA.

6. Preventive Measures For RA

Knowing what are the 4 stages of rheumatoid arthritis is not sufficient, you have to be aware of some preventive measures to reduce its risk.

  1. Doing exercise or yoga daily according to your health will be helpful.
  2. Stop smoking or nicotine consumption in any way.
  3. A healthy and balanced diet also plays a significant role in maintaining a healthy weight and also decreases the risk.
  4. To relieve the pain or swelling, heating pads or cooling packs will be very effective.
  5. Take proper medication, drugs, and injections.
  6. Try out some therapies and acupuncture to get relief from joint inflammation.


This article on the 4 Stages of Rheumatoid Arthritis, is a complete guide on Rheumatoid Arthritis. The complete information is accessible and easy to understand by everyone even for those who don’t know about rheumatoid arthritis as well.

Hopefully, nothing is going to be missed in this article on what are the 4 stages of rheumatoid arthritis.

Whenever you experience pain, swelling, inflammation, and joint pain, then consult your doctor. Never ignore or take these symptoms, otherwise, you will lose your ability to move.

  1. Radu, Andrei-Flavius, and Simona Gabriela Bungau. “Management of rheumatoid arthritis: an overview.” Cells 10.11 (2021): 2857. ↩︎
  2. Bieber, Katja, et al. “Autoimmune pre-disease.” Autoimmunity Reviews 22.2 (2023): 103236. ↩︎
  3. van Vulpen, Lize FD, et al. “Synovitis and synovectomy in haemophilia.” Haemophilia 27 (2021): 96-102. ↩︎
  4. Lin, Jietao, et al. “A three-dimensional co-culture model for rheumatoid arthritis pannus tissue.” Frontiers in Bioengineering and Biotechnology 9 (2021): 764212. ↩︎
  5. Wald, Lawrence L., et al. “Low‐cost and portable MRI.” Journal of Magnetic Resonance Imaging 52.3 (2020): 686-696. ↩︎
  6. Kirkland, J. L., and T. Tchkonia. “Senolytic drugs: from discovery to translation.” Journal of internal medicine 288.5 (2020): 518-536. ↩︎

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Laveleena Sharma

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