What Are The 4 Stages of Rheumatoid Arthritis

what are the 4 stages of rheumatoid arthritis
Image by Sompongtom on Unlimphotos

Every person faces joint pain issues in their life. Arthritis is one of the common joint inflammation disorders that is more common in old age people. With the increase in age, the risk of arthritis has also increased. 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 such 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 Arthritis?

Rheumatoid arthritis
Image by Kuprevich on Unlimphotos

For the better treatment of rheumatoid arthritis progression, it is necessary to know about it at an early stage. As it occurs in four stages, the last stage is very serious and causes more severe symptoms.

But before that get to know about arthritis for a better understanding, then move to the part of what are the 4 stages of rheumatoid arthritis. And if you already know Arthritis, then dive on what are the 4 stages of rheumatoid arthritis without any doubt.

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 hence, 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

Types of Arthritis

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

1. Osteoarthritis

This usually occurs due to the increase in age. With the age, your bones started losing density, and also the cartilage that joins bones also degraded. Due to that reason, you feel pain and difficulty in the movement of hands and knee joints.

2. Psoriatic Arthritis

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

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 getting affected by this disorder.

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.

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 disorder, like rheumatoid arthritis.

Rheumatoid Arthritis

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

Rheumatoid arthritis
Image by Portokalis on Unlimphotos

Mostly, it affects the joint 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 men. And it is usually observed in middle-aged people. If you have the following situation then, start caring about your bones and joints.

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


The most common symptoms of RA are a 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 the 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.

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 the joints movement

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 too much weak that you can’t even move your joints. In severe cases, it turns into a loss of joint movement.

Types of Rheumatoid Arthritis

1. Juvenile Rheumatoid Arthritis

In children when the body mistakenly attacks its cells as foreign children, then the beginning of Juvenile Rheumatoid Arthritis happens. Pain and inflammation in the joints of children are common symptoms. 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.

2. Seropositive Rheumatoid Arthritis

Out of all the types of RA, this one is the most server type. This is because it doesn’t only affect the joints but also affects the other body parts including the lungs as well. And 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. For the diagnosis of Seropositive Rheumatoid Arthritis, anti-citrullinated protein antibodies play an important role. Their presence marked the development of seropositive RA.

3. Seronegative Rheumatoid Arthritis

Seronegative RA is very rare. The absence of rheumatoid factor and anti-CCP in the blood is marked as the sign of development of Seronegative Rheumatoid Arthritis. And 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. 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.

Let’s begin with what are the 4 stages of rheumatoid arthritis that you need to know and also about their treatment.

What Are the 4 Stages of Rheumatoid Arthritis

All the four stages are arranged in increasing order as per their symptoms and severity. The four stages of RA are such as synovitis, pannus, fibrous ankylosis, and bony ankylosis. It is always better to take precautions at an early stage otherwise it turns into a chronic disease. Each stage of rheumatoid arthritis RA progresses with the development of more pain and damage in joint tissues or joint lining.

As RA progresses, various changes has been 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 the treatment for the RA.

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 a 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 get affected in this stage.

synovial fluid in joints
Image by creativepic on Unlimphotos

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.

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 Synovectomy. It is a kind of surgery, in which the affected synovium is going to be removed through a surgical treatment.

2. RA Stage II: Pannus

The untreated first stage of rheumatoid arthritis reaches the next stage, Pannus. At this stage, the continuous inflammation in the synovial membrane and cartilage is going on. This continuous inflammation in cartilage, cause lots of damage to it, as a result, more pain and difficulty in motion happen.

Cartilage is a flexible tissue that covers the joint’s surface and gives resistance to frictional movement in the joints. It acts as a lubricant and helps in the smooth movent of bones.

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. And this results in the uncontrollable growth of synovial tissues and the formation of a clump, known as Pannus. The development of Pannus causes 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 tumor. Pannus can easily be detected through imaging tests including MRI, 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 used to reduce disease activity and the risk of joint deformities.

Corticosteroid drugs or nonsteroidal anti-inflammatory drugs are also used to control the RA progression. As this disease begins when the body mistakenly attacks its cells because some biological response modifiers or biological are also very effective to control the body’s immune response. Biological response modifiers are used only when there is no improvement observed through nonsteroidal anti-inflammatory drugs.

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. The symptoms of this stage are a combination of both the early stages of RA.

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. 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 to treat this stage of RA as well. As this stage is marked by the loss of motion and results in deformities hence, proper rest should be done by the patient.

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

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 reaches the fourth stage called the end-stage RA. Like its name, at this stage, the bones fuse and cause mobility issues. Although the joint tissue inflammation is stopped but also the damage is continued.

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

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

Bony Ankylosis Treatment

This stage is like following all possible professional medical advice to quickly get resolve this progressive disease. 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.

This is all about what are the 4 stages of rheumatoid arthritis. But here is not the end.

Surgical treatment
Image by pamai on Unlimphotos

You get complete infromation regarding ‘What are the 4 stages of rheumatoid arthritis’ but scroll more to know about its risk factors. This infromation will help you to reduces the chances of development of RA.

Risk Factors For Rheumatoid arthritis

Although 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 to know about what are the 4 stages of rheumatoid arthritis.

  1. Women are at higher risk than men.
  2. Although RA occur only in aged people but it is not specific to age.
  3. Smoking is responsible to increasing the risk of development of RA. Various studies have shown that nicotine consumption increases the risk of RA. And also turn it into worse if not quitting smoking.
  4. Overweight or obese persons are also at higher risk of RA. That’s why a healthy weight is very important.
  5. 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.

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. Do exercise or yoga on daily basis according to your health will be helpful.
  2. Stop smoking or nicotine consumption in any way.
  3. A healthy and balanced diet also plays significant role in maintaining a healthy weight and also decreases the risk.
  4. To relief 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 in joint inflammations.

This article on what are the 4 stages of rheumatoid arthritis, is like a complete guide on RA. And 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 lightly these symptoms, otherwise, you will loose your ability to move. That means you are moving towards the end stage of RA. Now, you will get the answer to what are the 4 stages of rheumatoid arthritis so let us known in the comment, which information is you find new.


While at times contributed by guest authors, our content is medically reviewed periodically by professionals for accuracy and relevance. We pride ourselves on our high-quality content and strive towards offering expertise while being authoritative. Our reviewers include doctors, nurses, mental health professionals, and even medical students. 

Do note that any information found on the site does not constitute legal or medical advice. Should you face health issues, please visit your doctor to get yourself diagnosed. Icy Health offers expert opinions and advice for informational purposes only. This is not a substitute for professional medical advice.


Please enter your comment!
Please enter your name here