Rheumatoid Arthritis and Your Joints

dream when you were first diagnosed with rheumatoid arthritis (RA). But after starting treatment, you've hopefully learned that remission — or at least low disease activity — is possible. In fact, it's likely the goal of a detailed treatment plan you worked with your doctor to create.

Treating your RA aggressively to prevent as much additional joint damage as you can sounds simple, right? But that doesn't mean it's easy to achieve. Getting there will require some in-depth work on your part. Lifestyle changes, like eating healthier, can boost your overall well-being. And moving more — even if it's the last thing you feel like doing — may help ease your stiff and achy joints.

Perhaps most important, you also have to stick with your treatment plan and keep open lines of communication about your experience with your health care team. Let them know if it feels like your medications aren't working. Some require longer to take effect than others. Talk to your doctor about side effects that you just can't live with. They may be able to switch you to another treatment that might do a better job of controlling your disease activity and getting you closer to remission.

Here's a look at the joint damage that can come with RA, and why taking steps to get the disease under control as soon as you can is key.

How RA Happens

Doctors aren't sure of the exact causes of RA. Your genes, hormones, and things in the environment may play a role.

Early Stage

Early stage RA is often called synovitis. You may start to notice tenderness, warmth, swelling, or some pain in the joints.

At this point, you may not see any redness or significant bone damage on an X-ray. You might have signs of osteoporosis, a weakening of your bones.

Your symptoms may come and go for short periods of time. Depending on how severe your RA is, a flare-up may last a few days or months.

Some other symptoms you might have include:

Morning joint stiffness
Joint stiffness after you've been inactive
Stiffness that lasts 30 minutes or longer
The same types of symptoms on both sides of the body
Fatigue
A low-grade fever now and then
Weight loss
Weakness

If you notice these symptoms, talk to your doctor. You may need to see an RA specialist called a rheumatologist to get a proper diagnosis.

What Might Help (Early Stage)

Moderate Stage

When your RA moves into the moderate stage, you may notice some new symptoms along with some of the issues you may have had during the early stage.

As RA gets worse, the pannus will begin to grow into the joint cavity. This causes the inflammation to worsen enough to damage and expose the surrounding cartilage — the tissue that surrounds the bones of the joint. As cartilage chips away, it may start to slowly expose bone.

You won't see any deformed joints yet. But you may see a decrease in nearby muscle mass. You might also get soft-tissue lesions such as nodules and tenosynovitis — an inflammation of a tendon.

Joint pain, stiffness, and swelling will become worse at this stage. You'll also start to notice less range of motion in your joints. The flare-ups tend to happen more frequently.

Severe Stage

When RA progresses from the moderate stage and worsens, it's considered to be severe RA. This stage is also known as fibrous ankylosis. The surrounding bone may start to fuse.

With severe RA, the damage to the cartilage around the joint cavity worsens and begins to expose, destroy, and chip away the bone underneath. This form of bone loss is known as periarticular osteoporosis.

When you have severe RA, you might get symptoms like:

More pain in your joints
Swelling and redness
Less range of motion
Loss of mobility

Physical deformities may start to appear around the joints. You may have muscle atrophy — the loss of muscle tissue.

Flare-ups may be more severe and happen more often. You may get tissue lesions or nodules outside the joint.

What Might Help (Severe Stage)

Terminal Progression (End Stage)

In end-stage RA, the inflammation stops as the joint becomes fibrous or the two bones between the joint begin to fuse. This is the most advanced stage of the disease. At this point, the affected joint may stop working.

The range of motion worsens, and other severe stage RA symptoms get worse, too. The pain will worsen, and you may have it during physical activity, rest, and overnight.

End-stage RA also causes weakness and may affect the quality of your day-to-day life.

To improve or restore joint function at this stage, you may need joint surgery known as arthroplasty.

What Might Help (End Stage)

Progression Isn't Inevitable

There's no cure for RA, but treatment options have advanced quite a bit in the last few decades. Starting a treatment plan soon after a diagnosis and sticking to it can help to delay it from getting worse.

Studies show that early diagnosis, paired with a prompt treatment plan that includes prescription medications like disease-modifying antirheumatic drugs (DMARDs) and biologic agents, have made better long-term health outcomes more likely. Experts note it's best to start your treatment within 12 weeks after you first notice symptoms or right after diagnosis. This period is called the "window of opportunity."

According to research, these drugs can help bring joint inflammation and pain quickly under control and make remission — the reduction or complete disappearance of any signs or symptoms of the disease — a realistic goal.

Reviewed by Brunilda Nazario, MD, Jan. 18, 2022

Sources

Mayo Clinic: "Rheumatoid Arthritis."

Arthritis Foundation: "Self-Help Arthritis Devices," "Rheumatoid Arthritis: Causes, Symptoms, Treatment, and More."

Medscape: "What are the four stages of progression of rheumatoid arthritis (RA)?"