Rheumatoid arthritis (RA) is a progressive autoimmune disease affecting the health of your joints and bones. There are 4 stages of RA, each used to classify the degree to which your disease has progressed and what medical treatments your health care provider may consider to manage your symptoms and target chronic joint inflammation. 

In this article, we’ll review risk factors for the disease, the four stages of RA, treatment options, and therapeutic diet considerations for long-term management. 

Rheumatoid Arthritis Overview 

Rheumatoid arthritis (RA), a type of inflammatory arthritis, is an autoimmune disease in which your immune system mistakenly attacks healthy cells of your joints, causing widespread joint inflammation, pain, and eventual joint destruction and bone erosion. Approximately 1.3 million people in the United States have this progressive disease. Women are up to 3 times more likely than men to experience disease onset, with risk increasing with age. (Source, Source) 

Risk Factors for Rheumatoid Arthritis 

Several factors may influence your risk of developing RA, including genetic predisposition, environmental factors, immune response, diet, and lifestyle. The following have been studied for their ability to increase risk of RA development and further exacerbate symptoms during disease activity: 

• family history
• stress
• cigarette smoke exposure
• sedentary lifestyle
• silica inhalation (from ceramics, construction, or mining) 
• Western-style diet (red meat, trans fats, highly refined grains, ultra-processed foods)  
• low intake of anti-inflammatory compounds (antioxidants, omega-3 fatty acids) 
• food and environmental allergies 

(Source, Source, Source) 

Rheumatoid Arthritis & Other Clustered Diseases 

Comorbidity involves the presence of multiple, intertwined diseases. Comorbid conditions are especially common in RA, due to chronic inflammation affecting multiple body systems. If you have RA, you may also be diagnosed with: 

• cardiovascular diseases
• neurological disorders 
• sleep disorders 
• bacteria or virus infection
• gut dysbiosis 
• small intestinal bacterial overgrowth
• periodontitis (gum disease) 
• respiratory diseases 
• hormonal and reproductive factors
• other autoimmune diseases like Hashimoto’s thyroiditis 

(Source, Source, Source, Source)

4 Stages of Rheumatoid Arthritis

Rheumatoid arthritis is typically polyarticular, meaning that it affects 5 or more of your joints at a time. Polyarticular RA can take years to develop, or it may occur over the course of a few days, known as explosive onset. It is often concentrated initially in your hands and wrists, although it can also affect your shoulders, elbows, ankles and feet. Typically, joint damage takes effect within the first few years of the disease, with 85% of people experiencing some level of swelling, impairment, or even deformity. (Source, Source, Source, Source) 

Rheumatoid arthritis can be categorized into 4 stages, each identified by a set of symptoms, their severity, and disease progression. These 4 stages are known as early stage RA, moderate stage RA, severe stage RA, and end stage RA. Progressing through each stage is dependent on your unique medical circumstances and how quickly you are diagnosed and receive treatment. (Source) 

Stage 1

Stage 1, also known as early stage RA, often does not present with any symptoms. If you do experience symptoms, these may include: 

• joint pain 
• joint stiffness
• joint swelling

(Source)  

Stage 1 symptoms, while unusual, are most likely to occur in the morning or after long periods of inactivity. Moving your body can help to decrease morning stiffness, but symptoms are likely to persist over several hours. If your joint stiffness resolves quickly with movement, you may instead be experiencing osteoarthritis, the most common form of arthritis. Osteoarthritis is due to wear and tear on joints and is not an autoimmune disease. (Source, Source) 

Early diagnosis and treatment of RA, especially within the first 6 months of symptom onset, can increase your chances of remission, a period of disease inactivity. Still, early diagnosis in stage 1 can be challenging as medical imaging technologies (like X-rays) of your joints and bones are unlikely to show damage, even though inflammation in your joint lining has already begun. (Source) 

Stage 2 

Stage 2 of rheumatoid arthritis, also known as moderate stage RA, is associated with the development of symptoms. Persistent symptoms occur as a result of damage to your bones and to joint tissue known as cartilage, but may also extend to other body systems. These include: 

• joint pain
• reduced range of motion
• joint mobility loss
• fatigue 
• depression 
• fever 

(Source) 

A number of medical imaging technologies including X-rays, magnetic resonance imaging (MRI), and ultrasound imaging can confirm and visualize the progression of your disease during this stage. These technologies may reveal osteoporosis around inflamed joints, a disease of decreased bone mass, or shifts in bone shape. Imaging may also reveal damage to the layer of bone below your cartilage, known as the subchondral bone. (Source, Source, Source) 

Stage 2 Blood Tests for Rheumatoid Arthritis 

If you have RA symptoms, your health care provider will order blood tests to assess inflammation and certain protein levels in your blood to confirm your diagnosis. 

Two notable proteins that are commonly measured include rheumatoid factor (RF) and anti-cyclic citrullinated peptides (anti-CCPs). Approximately 80% of people with rheumatoid arthritis will test positive for RF and 60%–70% of people will test positive for anti-CCPs. A positive lab result means you have seropositive RA — usually a more severe case of RA. If your lab results are negative for both RF and anti-CCPs, but you are experiencing symptoms associated with rheumatoid arthritis, you may have seronegative RA. This can mean your RA is still in an early stage. It may also mean that your symptoms are linked to a different condition. (Source, Source)

Stage 3

Stage 3 of rheumatoid arthritis is considered to be severe-stage RA. Joint cartilage becomes permanently damaged and your bones may erode or twist in shape. In addition to symptoms associated with stages 1 and 2, additional symptoms resulting from ongoing inflammation include: 

• muscle weakness
• ruptured tendons
• extended loss of mobility 
• deformities 
• lumps under the skin, known as nodules 

(Source, Source, Source, Source)

During this stage, imaging tests provide clear proof of cartilage damage, bone erosion, joint destruction, and osteoporosis. (Source)

Stage 4

Stage 4 of rheumatoid arthritis, known as end-stage RA, may include all your symptoms of stages 1 through 3, but is marked by further severity. Common joint areas, including your hands, knees, and hips, may become immobile. X-rays may reveal abnormal bone adhesions and, although rare, bone fusion resulting in complete loss of joint function. (Source)

Consult Your Health Care Provider to Determine Your Care Plan 

If you’ve been diagnosed with rheumatoid arthritis, your health care provider will work with you to reduce symptoms, slow damage, and improve your overall quality of life. 

A number of medications can support these efforts, including: 

• nonsteroidal anti-inflammatory drugs (to target pain and inflammation) 
• corticosteroids (to target pain and inflammation) 
• disease-modifying antirheumatic drugs (to change your immune response) 
• biologics (to target inflammation at a cellular level) 

(Source) 

Depending on the extent of your joint damage and your response to medication, you may qualify for surgery, including joint replacement or joint fusion. (Source) 

How a Personalized Diet May Support Rheumatoid Arthritis 

In addition to your treatment plan, certain therapeutic diets and foods may positively support your symptom management, improve your daily life, and slow progression through the four stages of RA. 

Mediterranean Diet

Based on current evidence, the Arthritis Foundation considers the Mediterranean-style diet to be a good nutritional plan to follow for those with RA. The Mediterranean diet focuses on fiber-rich vegetables, fresh fruits, nuts, whole grains, fatty fish, and extra virgin olive oil. The dietary plan also includes healthy lifestyle patterns such as eating locally, cooking from home, community support, and physical activity. (Source, Source)

Omega-3 Fatty Acids

Dietary interventions that focus on anti-inflammatory foods have been studied for their ability to reduce inflammation during autoimmune flare-ups and support long-term remission. For example, omega-3 fatty acids found in fatty fish (such as salmon, cod, and sardines), fish oil, and flaxseeds, can positively influence immune response. (Source, Source) 

In a 2020 review published in the Mediterranean Journal of Rheumatology, researchers found that omega-3 fatty acids may help decrease RA disease activity by reducing inflammation, thereby supporting long-term disease management. Further research is needed, as studies often vary based on the food source and dosage of omega-3 fatty acids. (Source) 

Extra Virgin Olive Oil

Another common therapeutic food used in the Mediterranean diet is extra virgin olive oil (EVOO), which contains compounds with anti-inflammatory properties. It is possible that EVOO may also help reduce RA symptoms when applied topically, or directly on the skin covering affected joints.

A small 2020 randomized controlled trial published in Rehabilitation Nursing Journal assessed the use of topical extra virgin olive oil (compared to other topical treatments) applied to fingers, toes, and knees of women experiencing early morning pain associated with RA. Participants reported that disease activity decreased with use of EVOO, compared to other topical treatments. (Source, Source) 

The Bottom Line on the 4 Stages of Rheumatoid Arthritis 

Progressing through the 4 stages of rheumatoid arthritis can be debilitating and may dramatically reduce your quality of life. While clinical research has previously focused on later stages of RA management, new evidence continues to emerge regarding the dietary and lifestyle interventions that can be considered in earlier stages. Such early intervention may help reduce disease activity and increase the chances of longer-term maintenance, or even remission. 

Consuming a diet rich in anti-inflammatory whole foods, maintaining activity levels, quitting smoking, and managing other conditions that tend to cluster with RA may lessen symptoms or even help to prevent the disease altogether if you have genetic risk. 

Navigating the latest research while balancing your unique needs shouldn’t be your burden to carry alone. Tapping into the community network and practitioner support provided by our WellTheory membership can ensure your individual needs are met and the nuances of your medical history are considered.