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What are the 4 stages of rheumatoid arthritis?

Medically reviewed by Sally Chao, MD. Last updated on June 27, 2023.

Official answer


Rheumatoid arthritis (RA) has no cure. Over time, RA tends to get worse, which is called disease progression. RA progresses in stages. There are four stages of RA based on X-ray studies of your joints:

  1. In the first stage of RA, joint X-rays do not show any joint damage.
  2. In the second stage of RA, joint X-rays show evidence of thinning bones around the joint and some bone destruction underneath the cartilage of the joint. (Bones that form joints have a smooth covering of protective tissue called cartilage.)
  3. In the third stage of RA, there is evidence of both cartilage and bone destruction, and there is a change in the function and structure of the joint, called deformity.
  4. Stage four of RA has all the findings of stage three, but now the joint has started to lose the ability to move. Boney tissue or other tissue fills the joint space and freezes the joint, called ankylosis.

This staging is important for planning treatment and to see if treatment is slowing the progression of RA.

  • RA can also be classified as early or established. If you have had RA symptoms for less than six months, you have early RA. After six months, it is called established RA.
  • Another way to classify RA is by disease activity. Based on your symptoms and a physical exam, your doctor may describe disease activity as low, moderate or high.

These classifications all help your doctor decide on the best treatment for you.

Symptoms and treatment

The most common first symptoms of RA are swelling and stiffness of the small joints in your hands. These include the joints of your fingers and wrists. As RA progresses, so do your symptoms. RA is a disease that affects more than just your joints.

Symptoms may include:

  • Aching pain in more than one joint on both sides of your body
  • Stiffness, especially in the morning
  • Tenderness
  • Swelling of joints
  • Weight loss
  • Fever
  • Fatigue

When treating RA, the goal is to slow down or stop disease progression. Drugs called disease-modifying anti-rheumatic drugs (DMARDs) are effective at slowing progression and relieving symptoms. They can be started as soon as RA is diagnosed.

Even with treatment, many people with RA have periods of flares when symptoms get worse, also called exacerbations. You will also have periods when symptoms are under control, called remissions. Although there is no cure, treatment can improve symptoms, slow progression and improve quality of life.

Progression of RA can also be slowed by making the right lifestyle decisions:

  • Stopping smoking. Many studies show that smoking makes RA worse.
  • Like other people, people with RA should try to get 30 minutes of exercise on at least five days of the week. There are special physical activity programs for RA for those who need support.
  • Maintaining a healthy weight with a healthy diet and exercise reduces stress on your joints, which can improve RA symptoms.
  1. Chauhan K, Jandu JS, Goyal A, et al. Rheumatoid Arthritis. StatPearls [Internet]. 2020 Nov. 5. Available at: [Accessed May 25, 2021].
  2. Centers for Disease Control and Prevention (CDC). Rheumatoid Arthritis (RA). July 2020. Available at: [Accessed May 25, 2021].

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