Rheumatoid arthritis (RA) is an autoimmune condition that leads to inflammation, stiffness, and pain in joints, often affecting the hands, wrists, knees, feet, and ankles.

Symptoms can vary depending on the stage of RA. In its early form, symptoms may appear intermittently, but as the condition progresses, they tend to become constant and can cause irreversible joint damage.

Early Rheumatoid Arthritis

In the initial phase, many people remain undiagnosed due to the nonspecific nature of symptoms. RA may be mistaken for other causes of joint discomfort.

Common early-stage symptom patterns include:

  • Gradual, intermittent pain and stiffness in one or two joints that worsens over several weeks

  • Sudden, intense joint pain in a small area

  • Pain that appears and disappears over months (palindromic symptoms)

Some individuals show early signs of RA in blood tests, even before a diagnosis is confirmed. This stage is often referred to as “pre-RA.” The first six months after diagnosis are also considered early RA.

In this stage, fewer parts of the immune system are involved. In rare cases, symptoms may resolve on their own, but researchers continue to explore why this occurs.

Established Rheumatoid Arthritis

When RA symptoms persist for more than six months, the condition is categorized as established. At this stage, diagnosing RA becomes easier and more parts of the immune system are typically active.

Flares can still occur, and symptom severity differs widely. Some experience pain in a few joints, while others may have more widespread discomfort.

Pain may worsen over time but is often influenced by the effectiveness of treatment.

Advanced Rheumatoid Arthritis

If untreated or poorly managed, RA may progress into advanced or “end-stage” RA. In this stage, joints may become permanently damaged or deformed.

This can lead to significant mobility issues. In the hands, fingers may twist or bend unnaturally. Advanced RA causes chronic pain and increases the risk of complications such as heart and lung conditions.

X-Ray Stages of Rheumatoid Arthritis

RA progression is sometimes assessed through imaging, especially X-rays, to determine joint damage. Stages include:

  • Stage 1: No visible changes on X-rays; minor changes might appear on MRI

  • Stage 2: Some cartilage loss causing stiffness and limited movement, but no deformity

  • Stage 3: Significant bone and tissue damage with visible joint deformities

  • Stage 4: Bone fusion and severe damage, making joint movement very difficult

Generally, pre-RA and early RA fall into stage 1, established RA into stage 2, and advanced RA into stages 3 or 4.

Disease-Modifying Treatments

DMARDs (disease-modifying antirheumatic drugs) are the standard treatment across all RA stages. They help reduce inflammation, flares, and the risk of disease progression.

Types of DMARDs include:

  • Traditional oral DMARDs (e.g., methotrexate/Trexall)

  • Biologic DMARDs, derived from living organisms, given by injection or infusion (e.g., Enbrel, Actemra)

  • Targeted synthetic DMARDs, taken orally (e.g., Xeljanz)

Methotrexate is often the first drug prescribed. If it doesn’t work well, your doctor may adjust your treatment plan with other DMARDs.

How Rheumatoid Arthritis Progresses

RA doesn’t follow a single path. Some individuals with pre-RA may see symptoms disappear. However, once established, RA often progresses unless effectively managed.

Advanced stages are now less common due to improved treatments.

How To Slow RA Progression

Timely treatment is critical. DMARDs reduce flare frequency and severity, helping to slow joint damage.

Finding the right medication may take time. Monitoring through blood tests and scans helps guide adjustments. It’s important to communicate with your provider if symptoms persist despite treatment.

Managing Rheumatoid Arthritis

Managing RA involves both medical and lifestyle strategies. These may include:

  • Physical therapy to improve movement and reduce pain

  • Occupational therapy for assistive tools and techniques

  • Mental health support for managing stress and sleep

  • Pain relief through heat, massage, medications, or acupuncture

  • Gentle exercises like yoga or tai chi to maintain mobility

When symptoms remain severe, surgical intervention may be recommended based on joint damage.

When To See a Healthcare Provider

If you have joint pain—whether or not you've been diagnosed—seeing a healthcare provider is essential. For those already diagnosed, regular visits are important to track and adjust treatment.

Early evaluation improves the chance of managing symptoms effectively and avoiding long-term damage.

A Quick Review

Rheumatoid arthritis is a progressive autoimmune disease that causes joint inflammation and damage. Symptoms depend on the disease stage, and treatment is crucial to prevent worsening.

Starting DMARDs early and staying consistent with care can significantly reduce symptoms and protect joint health.