Massage Therapy Journal Summer 2026

36 • Massage Therapy Journal

The Four Stages of RA

AMTA Continuing Education

Healthy Joint

Stage 1

Stage 2

Stage 3

Stage 4

facilitates the formation of effective treatment for RA symptoms. Progression through all four stages can take many years, and some people don’t progress through all stages. The typical RA stages are: 15 Stage 1. Early-stage RA. Many people feel joint pain, stiffness or swelling due to inflammation inside the joint. Stiffness and pain, such as in the finger joints and knuckles, may disappear with movement. There is no damage to the bones yet, but the synovium is inflamed. Diagnosis in Stage 1 is not easy or common, but appropriate treatment in this stage can cause remission of symptoms. Stage 2. Moderate-stage RA. The synovium’s inflammation damages cartilage and bone, causing pain and loss of joint mobility. Despite these symptoms, blood tests may not show any sign of RA antibodies at this stage (RA antibodies may be negative because a small subset of people with RA are and may remain zero-negative to antibody presence). Stage 3. Once RA progresses to stage 3, symptoms have become severe, with damage to the cartilage and bone destruction. Cartilage erosion and bones rubbing together cause significant pain and joint swelling. Muscle weakness is more noticeable, and joint mobility more limited. Changes in joint formation may occur, including twisted fingers and thickened knuckles, compressed tendons at the wrist, and symptoms of carpal tunnel syndrome or tendon rupture (the rupture of extensor tendons on the

fingers due to synovitis at the wrist is a major risk, but this can be prevented if identified early). Stage 4. At stage 4, there’s no longer inflammation in the joint; this is end-stage RA, when joints no longer work as they should. In end-stage RA, people may still experience pain, swelling, stiffness and mobility loss, and decreased muscle strength. Bones at joint ends may fuse (ankylosis) for a small number of people with RA, As in other autoimmune diseases, people with RA experience occasional flares or exacerbations of symptoms. When it comes to defining exacerbations, doctors and patients often don’t agree, and even individual RA patients have differing definitions. Types of exacerbations. Long-time RA patients can often become adept at predicting and identifying early signs of an exacerbation. 13 • Predictable exacerbations have a known trigger. Typically, predictable flares are temporary and will resolve in time. • Unpredictable exacerbations are less avoidable. Symptoms may be worse, but do not have a trigger, and may not get better with time. • Repeated or consistent exacerbations may need a medication adjustment or other change in treatment. Pain, stiffness and fatigue are common exacerbation themes, but duration, severity and and movement becomes more difficult. What Can Exacerbate RA?

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