Rheumatoid Arthritis can be put into five stages where each stage is characterized by the status of the uncontrolled inflammation that is present in the joints of the body.
This is when people with RA don’t have any symptoms of arthritis and their joints appear normal. Just because somebody has the RA gene marker, doesn’t mean that they will automatically develop it. The factors that actually trigger the development are still unknown. To make it even better, unknown factors trigger the inflammatory process and some other unknown trigger keeps going by not allowing the normal inflammation process to happen.
This is when people with RA start having the first symptoms. During the beginnings of this stage, the development of synovitis occurs (synovitis is when the synovium becomes inflamed). There is also an increase in the development of two cytokines in particular that cause significant increase in inflammation. The continued production of chemicals related to RA in the body can also cause fatigue as well as swelling, warmth, and pain in the joints. During stage 2, there is a production of plasma cells that are responsible for producing antibodies. Antibodies (also known as immunoglobulins) are what the body normally produces to fight against viruses and bacteria that are not normally present in the body. In the case of RA, the body produces an excessive amount of the antibodies. One of the antibodies is called the rheumatoid factor. (Read more about the rheumatoid factor here in osteoarthritis vs rheumatoid arthritis)
There’s an increase in the amount of synovial fluid in the joint adds to the stiffness and puts a limit on the motion of the joints. (Joint effusion is when there is an accumulation of fluid in the joint) In the synovial joint fluid there is a lubricating substance called hyaluronic acid. With RA, there is an increase of this acid that many people believe is the reason for morning stiffness because after sitting for a long period of time the without moving causes a gelling of the acid in the synovial fluid. In any of the three earliest stages of RA, a person may experience joint symptoms including pain, heat, swelling, stiffness, and a loss of motion. But, all of these are potentially reversible with the proper medical therapy.
During this stage, the synovium that is inflamed can grow and spread over the top of the cartilage in the joint. There can be the breakdown or degrading of the cartilage that protects the bones and joints. There can also be the breaking down of the bone where the synovitis meets the bone and tiny holes (or erosions) can be formed in the bone and cartilage. Erosions most often happen first at the point at which the protective cartilage ends at the margins of joints.
If the arthritis is left untreated, there can be further erosion through the cartilage and bone. Any loss of this cartilage reduces the amount of cushioning that is between the bone and the joint. After the cartilage becomes rough due to the erosion, the smooth movement of that particular joint is gone and sometimes a grating sensation can be felt during movement. This is called crepitus.
Early symptoms of RA include pain, swelling, warmth, and stiffness (especially in the morning) of the joints and a mild restriction of motion. Joint symptoms and other symptoms categorized as fatigue are caused by variety of inflammatory substances that are produced by different cells. In RA, the normal cells of the joint lining and white blood cells become overactivated and result in uncontrolled inflammation of the joints. The reason why is still unknown.
Early stages of RA are often reversible with timely medical therapy.
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