What are the 4 stages of progression of rheumatoid arthritis (RA)?

Updated: Mar 05, 2021
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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To determine the progression of RA, patients are categorized by clinical and radiologic criteria into 4 stages, as follows:

  • Stage I (early RA) – No destructive changes observed upon radiographic examination; radiographic evidence of osteoporosis is possible

  • Stage II (moderate progression) – Radiographic evidence of periarticular osteoporosis, with or without slight subchondral bone destruction; slight cartilage destruction is possible; joint mobility is possibly limited, but no joint deformities are observed; adjacent muscle atrophy is present; extra-articular soft tissue lesions (eg, nodules and tenosynovitis) are possible

  • Stage III (severe progression) – Radiographic evidence of cartilage and bone destruction in addition to periarticular osteoporosis; joint deformity (eg, subluxation, ulnar deviation, or hyperextension) without fibrous or bony ankylosis; muscle atrophy is extensive; extra-articular soft tissue lesions (eg, nodules, tenosynovitis) are possible

  • Stage IV (terminal progression) – Presence of fibrous or bony ankylosis, along with criteria of stage III

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