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What you need to know about stage 1 early rheumatoid arthritis in hands

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Stage 1Stage 2Stage 3Stage 4RA progressionTreatmentsSummary
Rheumatoid arthritis (RA) is an inflammatory condition that can often affect your hands and causes joint pain and stiffness. It progresses through four stages, starting with stage 1.
Medically reviewed by Margaret R. Li, MD, FACR
Updated on

Rheumatoid arthritis (RA) can affect the joints in your hands. This may cause inflammation and damage to the internal tissues, such as the cartilage that acts as a cushion between your bones. The inflammation may also lead to pain and swelling in your hands.

It is possible for RA to progress. Healthcare professionals categorize this progression into four different stages:

  • stage 1, or early stage of RA
  • stage 2, or moderate RA
  • stage 3, or severe RA
  • stage 4, or end stage RA

This article will review the stages of RA, their symptoms, and the treatment options available.

Stage 1, or early stage of RA

An image of someone with their palm facing outward, holding their wrist with the other hand.
1148111647SCIENCE PHOTO LIBRARY/Getty Images

In more than 50% of cases of RA, people do not notice any symptoms when the condition first starts to develop (known as the onset of the condition), according to a 2020 condition overview.

In the early stages of RA in the hands, inflammation may develop in the joint. This can also lead to swelling in the connective membranes that separate the bones.

The onset of RA can occur up to 10–15 years before a person starts experiencing any symptoms of this condition, the 2020 overview found.

Diagnosing the condition in its early stages can significantly prevent its progression. But because symptoms in the first months and weeks are typically very mild, it may be difficult to diagnose.

Receiving treatment for RA within the first 12 weeks of the start of your symptoms can lead to a better outlook for the condition.

A healthcare professional may prescribe the following medications, either individually or, in some cases, as a combination to reduce inflammation and pain.

Medications for RA include:

  • corticosteroids, such as prednisone (Deltasone)
  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve)
  • disease-modifying anti-rheumatic drugs (DMARDs), which include biologics such as infliximab (Remicade)

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Stage 2, or moderate RA

During stage 2 of RA, inflammation of the joints may occur. This can cause damage to the cartilage that divides the bones in the joint and acts as a cushion to prevent friction.

Imaging tests may help doctors identify the damage occurring in your hand. It is recommended that you undergo testing periodically to assess the progression of RA.

These tests may include:

People with stage 2 RA in their hand may experience the following symptoms:

  • locking or the triggering of the fingers
  • swelling, which may also affect the hand’s tendons
  • fatigue
  • fever

In stage 2, a healthcare professional may prescribe a combination of medications similar to those prescribed in stage 1 RA. This includes NSAIDs, corticosteroids, and DMARDs.

They may also recommend wearing an assistive device, like braces, to help support you in your daily activities and reduce any pain. A doctor may also refer you to a physical therapist, who can help you do physical exercises to improve the mobility of your hand.

Stage 3, or severe RA

In stage 3 RA, the inflammation destroys and erodes cartilage and bones in the hand. This can result in the following symptoms:

  • further swelling and pain
  • weakening of muscles in your hand
  • the compression and rupture of tendons in your hand

At this stage, a doctor may recommend the following treatment options:

  • medications such as DMARDs to help with inflammation levels
  • physical therapy
  • surgery on the hand, such as arthroplasty

People with stage 3 RA may also experience structural changes in their fingers or the formation of nodules near the joints.

Stage 4, or end stage RA

Those with end stage RA will no longer have inflammation in the joints of their hands. This is because the joints will have stopped working after sustaining severe damage over the years.

In the final stage of RA, joint destruction may cause the bones to fuse together, known as ankylosis. People with stage 4 RA may have certain physical limitations and may need to use assistive devices to carry out daily activities.

How quickly does early rheumatoid arthritis in hands progress?

The progression and the symptoms of RA in hands can vary from person to person. In some cases, the condition may quickly progress over weeks. But in most cases, RA progresses over a period of months or years.

When arthritis progresses, you may develop a flare-up of your symptoms. These can include:

  • increased joint swelling and pain
  • fatigue
  • dry or painful eyes
  • increased frequency and duration of flare-up episodes
  • the onset of RA nodules
  • ongoing damage, diagnosed via imaging tests
  • increased levels of inflammatory markers in your blood

Can it be reversed?

Currently, there is no cure for RA in the hands. However, treatment for RA is available. Current treatments for RA mainly focus on slowing down and preventing the progression of this condition.

DMARDs can help block the release of chemicals in your body that cause your immune system to react and attack your joints. DMARDs are typically effective, but it may take a couple of months before people with RA notice a reduction in symptoms.

Examples of DMARDs that can help treat RA include adalimumab (Amjevita) and etanercept (Erelzi).


RA is a chronic inflammatory condition that can cause damage to the joint. A person with RA may experience joint inflammation and swelling in its early stages. However, when RA progresses, it can cause the destruction of the cartilage and the erosion of the bones in the affected joint.

Though there is no cure for RA, treatment aims to slow down the progression of the condition and improve quality of life. Treatment can include taking NSAIDs, corticosteroids, and DMARDs. In some instances, surgery may also be a treatment option.

A healthcare professional may refer a person with RA to a physical therapist to improve the mobility and strength of their joints.

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