Stages of RA

Early detection and treatment to control inflammation is of critical importance in RA, given the potential for
rapid destruction of joint and other tissue and impairment of functioning. Although how RA progresses in
individual patients and the pattern of joint involvement varies widely from patient to patient, in the majority of
patients with RA (70%) some degree of joint erosion in the hands and feet is detectable by x-ray within the
first two years of the disease.1
Without adequate treatment, at 20 years after diagnosis, more than 60% of patients with RA may develop
significant functional impairment (stage III), including need of mobility aids, loss of ability for self-caring, and
requirement of joint replacement, or experience loss of independence and require daily care (stage IV).1
 
Stage I.
Early stage RA (stage I) is characterized by synovitis, or an inflammation of the synovial membrane, causing
swelling of involved joints and pain upon motion. During this stage, there is a high cell count in synovial fluid
as immune cells migrate to the site of inflammation. However, there is generally no x-ray evidence of joint
destruction, with the exception of swelling of soft tissues and possibly evidence of some bone erosion.3
Stage II.
In moderate RA, stage II, there is a spread of inflammation in synovial tissue, affecting joint cavity space
across joint cartilage. This inflammation will gradually result in a destruction of cartilage, accompanied by a
3
narrowing of the joint.
Stage III.
Severe RA, stage III, is marked by formation of pannus in the synovium. Loss of joint cartilage exposes bone
beneath the cartilage. These changes will become evident on x-ray, along with erosions around the margins
of the joint. Joint deformities may also become evident.3
Stage IV.
Stage IV is called terminal or end stage RA. The inflammatory process has subsided and formation of fibrous
tissue and/or fusing of bone results in ceased joint function. This stage may be associated with formation of
subcutaneous nodules.3

Stages of RA

I
Synovitis characterized by:
Swelling of synovial membrane with excess of blood
Small areas of lymphocyte infiltration in membrane
Synovial fluid with high cell counts (5,000 to 60,000 per mm3)
X-ray shows soft tissue swelling and possibly osteoporosis, but no evidence of joint destruction

II
Proliferation of inflammation in joint tissue, spreading into joint cavity across joint cartilage
Joint cartilage shows signs of gradual destruction
Loss of joint cartilage results in a narrowing of joint

III
Synovial pannus forms
Joint cartilage becomes eroded and bone beneath cartilage is exposed
X-ray shows extensive loss of cartilage, joint erosion (around margins), and possible deformities

IV
Disease reaches end stage with inflammatory process subsiding
Loss of joint function
Subcutaneous nodules form