As rheumatoid arthritis (RA) progresses and expresses itself, it varies widely from patient to patient. This variability is manifested in models of articular involvement, as well as in the degree of participation in diseases outside the joints, including the development of rheumatoid nodules, lung involvement, and other complications associated with RA. One patient may experience symptoms of RA that affect only small joints, while another may have symptoms that affect only large joints. Other patients will experience a more common disease that affects a number of joints, regardless of their size. There are also wide differences among patients in how active the disease is and how quickly structural damage in the joints develops. In this article, we will consider the stages of rheumatoid arthritis. Medication for rheumatoid arthritis .
Are the symptoms of RA persistent throughout the illness?
For most patients with RA, the incidence will fluctuate over time. For example, in most patients, periods last from a few weeks to several months when symptoms increase or worsen. For many patients, a predictable long-term picture of disease activity may develop that lasts throughout the course of the disease.
For a minority of patients, about 10 – 20%, active disease can persist throughout the course of the disease.
What is the likelihood of remission of the disease
Long-term remission of the disease will occur in a small percentage of patients with RA and is associated with appropriate early treatment. In one study, in which, in the first year after diagnosis, 191 patients with RA were included. They were treated with anti-rheumatic drugs (during the first year after diagnosis). One quarter experienced a remission of the disease after receiving treatment for three years, and this remission continued after 5 years with continued treatment in 16% (30 of 191) of patients.
In this study, there were several factors that predicted the likelihood of prolonged remission (after 5 years). In general, patients with a milder disease with a diagnosis had a greater chance of remission with treatment. Factors, including those with low disease activity (as measured by the standard indicator used to assess disease activity), a more favorable assessment of health status (measured by the Health Assessment Questionnaire or HAQ). Low levels of C – reactive protein (CRP) (<14.5 mg / L), low articular pain (measured on the Ritchie scale), and lower morning stiffness predicted a greater likelihood of remission. What are the stages of rheumatoid arthritis?
Stages of Rheumatoid Arthritis
Early detection and treatment to control inflammation are crucial in rheumatoid arthritis, given the possibility of rapid destruction of articular and other tissue and impaired functioning. Despite the fact that RA progresses in individual patients, and the nature of articular involvement varies widely from patient to patient, in most patients with RA (70%), a certain degree of joint erosion in the arms and legs is detected by x-ray during the first two years of illness.
Without adequate treatment, 20 years after diagnosis, more than 60% of patients with RA can develop significant functional impairments (stage III), including the need for mobility, loss of self-care and the need to replace joints or loss of independence and the need for daily care (stage IV).
The early stage of RA (stage I) is characterized by synovitis or inflammation of the synovial membrane, causing swelling of the joints involved and pain during movement. At this stage, a high number of cells is observed in the synovial fluid, as immune cells migrate to the site of inflammation. However, as a rule, there is no X-ray evidence of joint destruction, with the exception of soft tissue swelling and possibly signs of any kind of bone erosion.
In moderate rheumatoid arthritis, stage II, the spread of inflammation in the synovial tissue is observed, affecting the space of the joint cavity through the articular cartilage. This inflammation will gradually lead to the destruction of cartilage, accompanied by a narrowing of the joint.
Severe RA, stage III, is marked by the formation of pannus in the synovial membrane. Loss of articular cartilage exposes the bone under the cartilage. These changes will become apparent in the x-ray, along with erosion around the edges of the joint. Joint deformities can also become apparent.
Stage IV is called the terminal or end-stage of rheumatoid arthritis. The inflammatory process has decreased, and the formation of fibrous tissue or bone fusion has led to the cessation of joint function. This stage may be associated with the formation of subcutaneous nodules. How to diagnose rheumatoid arthritis ?
Synovitis is characterized by:
- Tumor of the synovial membrane with excess blood.
- Small areas of lymphocyte infiltration in the membrane.
- Synovial fluid with a high number of cells (from 5,000 to 60,000 per mm3).
- Radiography shows soft tissue swelling and possibly osteoporosis, but no evidence of joint destruction.
- The spread of inflammation in the joint tissue, the spread into the joint cavity through the articular cartilage.
- The articular cartilage shows signs of gradual destruction.
- Loss of articular cartilage leads to a narrowing of the joint.
- Synovial forms of pannus.
- The cartilage of the joint becomes eroded, and the bone under the cartilage is exposed.
- X-rays show extensive cartilage loss, erosion of the joints (around the site) and possible deformations.
- The disease reaches the final stage with the inflammatory process.
- Loss of articular function.
- Subcutaneous nodules.
These are the main stages of rheumatoid arthritis. Early signs of rheumatoid arthritis .