4 stages and classes of rheumatoid arthritis

Rheumatoid Arthritis Symptoms
The exact cause of RA remains unknown, but several risk factors have been identified.

The American College of Rheumatology classifies rheumatoid arthritis into four stages, based on the disease progression and radiologic findings:

  • Stage I (early RA):  X-ray does not reveal any critical changes in the bones, although there may be signs of bone thinning.
  • Stage II (moderate progression): Radiologic findings reveal minimal destruction of bones and cartilages.
    • Joint movements are restricted.
    • Slight cartilage damage is possible
    • Atrophy of adjacent muscle
    • Abnormalities of soft tissue around the joint are possible
  • Stage III (severe progression): Radiologic evidence suggests extensive muscle wasting and joint deformities.
    • Joint deformity without permanent stiffening or fixation of the joint
    • Extensive muscle atrophy
    • Abnormalities of soft tissue around the joint are possible
  • Stage IV (terminal progression): Radiologic findings suggest abnormal stiffening and immobility of joints with a fusion of joints (bone ankylosing).
    • On X-ray, evidence of cartilage and bone damage and osteoporosis around joint
    • Extensive muscle atrophy
    • Abnormalities of soft tissue around the joint are possible

Based on the function of the patient, rheumatoid arthritis can be classified as:

  • Class I:  Patients can perform daily activities independently.
  • Class II: Patients can perform self-care and job-related activities independently, however, the leisure activities may be limited.
  • Class III: Patients can perform self-care activities, however, job-related and leisure activities may be limited.
  • Class IV: Patients may have limited ability to perform day-to-day tasks.

What is rheumatoid arthritis?

Rheumatoid Arthritis (RA) Causes
The most common signs and symptoms of rheumatoid arthritis observed are pain in the joints of hands and feet.

Rheumatoid arthritis is a chronic inflammatory disease characterized by pain and inflammation in joints, typically of the hands and feet.  It is an autoimmune disease in which the immune system of the body attacks its own healthy cells, resulting in inflammation of the membrane lining the joints (synovial membrane) and damage to joint tissue. 

Rheumatoid arthritis also affects other organs such as the skin, heart, lungs, and eyes. The annual incidence of rheumatoid arthritis is approximately three cases per 10,000 people worldwide. 

What is the main cause of rheumatoid arthritis?

The exact cause of rheumatoid arthritis is unknown. However, some of the contributing factors to rheumatoid arthritis are:

  • Genetic factors
  • Some viruses and infectious agents 
  • Sex hormones 
  • Immune system disorder
  • Age between 35 and 50 years
  • High-risk ethnic backgrounds such as Native American
  • Female sex
  • Periodontal disease
  • Bowel infections
  • Having a close relative with RA 
  • Tobacco smoking
  • Obesity


What Is Rheumatoid Arthritis (RA)? Symptoms, Treatment, Diagnosis See Slideshow

What are the symptoms and signs of rheumatoid arthritis?

While rheumatoid arthritis is a chronic disease, there are times when symptoms worsen (flares) and times when the patient recuperates from the symptoms (remission). Some of the most common signs and symptoms of rheumatoid arthritis observed are:

  • Pain in the joints of hands and feet
  • Pain on motion
  • Swelling and tenderness in one or more joints
  • Restricted movements of the affected part
  • Deformity of the affected parts
  • Fever
  • Weakness 
  • Fatigue or tiredness
  • Numbness and tingling in the hand or arm
  • Osteoporosis (a condition in which bones become weak and brittle)
  • Muscle weakness

How can rheumatoid arthritis be diagnosed?

Rheumatoid arthritis can be diagnosed based on its clinical presentation in the joints as well as using the following blood tests:

Radiographic findings are used by the doctor to assess the arthritis progression. The physician may suggest magnetic resonance imaging (MRI) or joint aspiration for further evaluation.

What is the treatment for rheumatoid arthritis?

The goals of the treatment of rheumatoid arthritis include:

  • Pain relief
  • Improving the range of motion
  • Development of joint strength and stamina
  • Preventing joint destruction and deformities
  • Providing counseling to the patients

The treatment approach involves treating the disease with medication, education, and lifestyle modifications. 

Drugs used to treat rheumatoid arthritis are:

Surgical treatment can be required for severe joint damage.

What are the complications of rheumatoid arthritis?

Rheumatoid arthritis can lead to the following complications:

Rheumatoid arthritis is not curable but with appropriate treatment, the disease can be controlled.  Treatments are most effective when initiated early in the disease.

Does rheumatoid arthritis qualify for long-term disability?

The Social Security Administration (SSA) considers rheumatoid arthritis (RA) a qualifying disability, provided it is advanced enough to meet their eligibility requirements.

There may come a time when your RA is so severe that it becomes debilitating and you can no longer work in the office. Studies show that 35 percent of people left their jobs 10 years after their RA diagnosis.

While deciding to stop working might be your toughest decision yet, the stress of staying at your job despite being unable to work due to your condition could make you prone to depression.

Because of your rheumatoid arthritis, you may qualify for long-term disability benefits, but only if you fall under certain terms and conditions.


The term arthritis refers to stiffness in the joints. See Answer

What will you need to qualify for RA disability benefits?

First, to receive Social Security Administration (SSA) disability benefits, you will need to obtain a certificate from the government for your disability due to rheumatoid arthritis (RA). For this certificate, your RA symptoms should be so severe that they must significantly limit your ability to do basic work, such as lifting, walking, and even standing. Additionally, your condition has affected your life so much that you can’t perform your job, as well as any other job.

To qualify for disability benefits, your RA has to be severe enough to keep you out of work for at least 12 months, and you must also have enough work credits.

The entire process will need documentation from your rheumatologist in the form of the following:

  • X-rays
  • Magnetic resonance imaging (MRI) scans
  • Blood tests
  • Results of physical examination
  • A history of your treatment and results
  • A medical history that shows the duration and progression of your RA
  • Pictures of the affected body parts that depict the disability

Increase your chances of receiving disability benefits by enlisting the help of the following professionals:

  • Vocational specialist or physical therapist for your physical capacities evaluation
  • Psychologist or psychiatrist if you have depression or anxiety due to RA

Learn more about the process and list of required items by visiting https://www.ssa.gov/, which is the official government website for the SSA. You can also consult a disability lawyer or an advocate to ease the entire disability application process and increase your chances of qualifying for your benefits.

Expect to receive the results of your disability application generally in three to five months, though it may take more than one application to get qualified. If your request for disability benefits is rejected, you can appeal the decision by seeking help from an attorney.

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Medically Reviewed on 8/4/2022
Reference: https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html


Disability Evaluation Under Social Security. https://www.ssa.gov/disability/professionals/bluebook/14.00-Immune-Adult.htm

Arthritis in the Workplace. https://www.cdha.nshealth.ca/

Social Security Disability for Rheumatoid Arthritis: 8 Important Questions and Answers. https://creakyjoints.org/about-arthritis/rheumatoid-arthritis/ra-treatment/rheumatoid-arthritis-social-security-disability/