Rheumatoid arthritis is a lifelong inflammatory disease that can affect all parts of the body, though it typically affects the ankles, knees, wrists and fingers on both sides of the body. Symptoms of this condition are fever, weakness, swelling, pain and deterioration of the affected joints. It also involves periods of unpredictable flare-ups and partial remission. The book "Straight A's in Pathophysiology" explains that rheumatoid arthritis progresses in four stages 15.
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Stage 1
The first stage of rheumatoid arthritis is characterized by a condition called synovitis. There is no severe damage in this stage, but the synovial lining, the lining of the joint, swells. As a result, patients experience pain, redness, warmth, stiffness and inflammation around the affected joints. "Imaging of the Head and Neck," by Mahmood F. Mafee, Galdino E. Valvassori and Minerva Becker, says that osteoporosis is seen in the first stage of rheumatoid arthritis 2. X-rays may also reveal signs of swollen soft tissues in the joint.
- The first stage of rheumatoid arthritis is characterized by a condition called synovitis.
- X-rays may also reveal signs of swollen soft tissues in the joint.
Stage 2
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The second stage of rheumatoid arthritis involves the thickening of the synovial lining, or synovium. This happens when the cells of the synovium grow and divide at an accelerated rate. As the synovium grows, it covers the cartilage and can eventually destroy the joint capsule and bone.
Stage 3
The damage done in stage 3 rheumatoid arthritis is quite severe. The inflamed cells of the synovium release enzymes that may digest the bone and cartilage in the joint. This causes deformities, loss of movement, partial dislocations, muscle wasting and pain in the joint. At this point, X-rays will show severe loss of cartilage and erosion around the edges of the joint.
- The damage done in stage 3 rheumatoid arthritis is quite severe.
- The inflamed cells of the synovium release enzymes that may digest the bone and cartilage in the joint.
Stage 4
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Stage 4 rheumatoid arthritis is the end stage of the disease 5. The inflammatory process begins to die down, the joint becomes less functional and may become totally immobile. "Exercise Testing and Exercise Prescription for Special Cases: Theoretical Basis and Clinical Application," by James S. Skinner, says that in this stage, changes from the previous stages are observed 3. "Physiotherapy in Orthopaedics: A Problem-Solving Approach," by Karen Atkinson, Fiona Coutts and Anne-Marie Hassenkamp, explains that irreversible cartilage destruction occurs at this stage 4.
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References
- "Straight A's in Pathophysiology"; Lippincott Williams & Wilkins; 2006
- "Imaging of the Head and Neck"; Mahmood F. Mafee, Galdino E. Valvassori and Minerva Becker; 2005
- "Exercise Testing and Exercise Prescription for Special Cases: Theoretical Basis and Clinical Application"; James S. Skinner; 2005
- "Physiotherapy in Orthopaedics: A Problem-Solving Approach"; Karen Atkinson, Fiona Coutts and Anne-Marie Hassenkamp; 2005
- Wheeless' Textbook of Orthopaedics: Stages of Rheumatoid Arthritis
- Redondo ML, Christian DR, Yanke AB. The role of synovium and synovial fluid in joint hemostasis. In: Yanke A, Cole B, eds. Joint Preservation of the Knee. Cham, Switzerland: Springer; 2019: 57-67.
- Yap HY, Tee SZ, Wong MM, Chow SK, Peh SC, Teow SY. Pathogenic role of Immune cells in rheumatoid arthritis: implications in clinical treatment and biomarker development. Cells. 2018;7(10). doi:10.3390/cells7100161
- Ostrowska M, Maśliński W, Prochorec-Sobieszek M, Nieciecki M, Sudoł-Szopińska I. Cartilage and bone damage in rheumatoid arthritis. Reumatologia. 2018;56(2):111-120.
- Ouboussad L, Burska AN, Melville A, Buch MH. Synovial tissue heterogeneity in rheumatoid arthritis and changes with biologic and targeted synthetic therapies to inform stratified therapy. Front Med (Lausanne). 2019;6:45. doi:10.2174/1874312901105010115
- Medication Guides. American College of Rheumatology. Updated 2020.
- Mathiessen A, Conaghan PG. Synovitis in osteoarthritis: current understanding with therapeutic implications. Arthritis Res Ther. 2017;19(1):18. doi:10.1186/s13075-017-1229-9
- Smith MD. The normal synovium. Open Rheumatol J. 2011;5:100-6.
Writer Bio
Ngozi Oguejiofo has been writing on a freelance basis since 2009 and most of her writings are focused on health. She is currently a registered nurse. She is interested in teaching, and writes articles focused on student nurses for various online publications.