Treating Severe Rheumatoid Arthritis

How Treatment Options Change in Stage 3 Disease

Arthritis X-ray
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Rheumatoid arthritis is an inflammatory autoimmune disease in which the body's immune system inadvertently attacks the synovial fluid that lubricates the joints. Its cause is not entirely known but is believed strongly linked to genetics.

The Centers for Disease Control and Prevention estimates that as many as 1.5 million Americans are affected by rheumatoid arthritis with symptoms ranging from transient aches and pain to serious disability.

When the symptoms of rheumatoid arthritis are severe, doctors will take more aggressive action to reduce the inflammation and stifle the immune response. If left untreated, rheumatoid arthritis can affect more than just your mobility; its inflammatory effects can trigger serious complication in other parts of the body, as well.

The severity of rheumatoid arthritis is graded by stages, with stage one being the least severe and stage four being the most.

Characterizing Severe Rheumatoid Arthritis

When assessing the severity of rheumatoid arthritis, doctors will consider your symptoms, the degree of joint damage, and the impact on your physical function to better determine the course of treatment.

Symptoms of severe rheumatoid arthritis typically include a high level of pain, stiffness, and/or swelling of the affected joints. You may have trouble performing daily tasks or experience the deformity of arthritic joints, especially those of the hands.

The inflammatory response can also affect other organs, leading to systemic symptoms such as persistent fatigue, pericarditis (inflammation of the membrane surrounding the heart), vasculitis (inflammation of the blood vessels), and pleuritis (inflammation of the lining of the lungs).

The severity of rheumatoid arthritis symptoms has a direct impact on a person's ability to function and can even affect a person's ability to work.

A 2008 study from Boston University reported that, even with far improved biologic drugs and treatments, the progression of the disease is linked to increasing rates of work cessation before the age of 65 affecting:

  • 23 percent of adults who have had rheumatoid arthritis for one to three years
  • 35 percent of those who have lived with the disease for at least 10 years
  • 51 percent of those who have lived with the disease at least 25 years

Diagnosing Severe Rheumatoid Arthritis

While physical exams, imaging studies, and lab tests are key to determining the severity of your condition, so, too, are your own perceptions of your pain and disability. In fact, these as just as important as the other tests in determining your ultimate treatment plan.

Some people, for example, will often show less physical damage on lab tests but have a greater perception of disability that almost always translates to increased levels of impairment and depression.

By contrast, a person with extensive damage can often be more functional and better able to cope. While this wouldn't necessarily exclude more aggressive treatments (if only to slow disease progression and prevent systemic illness), it may determine which types of complementary therapy (including exercise or physical therapy) would be most appropriate.

To evaluate your functional disability, doctors will often conduct a self-assessment survey, such as a Health Assessment Questionnaire, by which you would be asked to score your mood, level of pain, and degree of impairment.

If faced with severe rheumatoid arthritis, whatever your level of disability, a specialist rheumatologist may be needed to oversee your care. These doctors have a better understanding of the dynamics of this still-elusive disease and are more likely to be appraised of current or experimental treatments.

Treatment of Severe Rheumatoid Arthritis

The stages of rheumatoid arthritis are defined as early (stage one), moderate (stage two), and severe (stage 3).

Stage four is considered end-stage disease when the inflammatory process ceases and the joints stop functioning altogether.

To prevent progression from stage three to four, therapy will rely upon more potent medications. Where in the past, you may have found pain relief with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), you may now require cortisone shots and/or stronger painkillers to achieve similar effect.

In addition, your doctor will likely place you on a different combination of medications aimed at slowing the disease activity. These include:

In some cases, surgery may be needed to the debride areas of damage and restore mobility and range of movement to the affected joint.

Sources:

Allaire, S.; Wolfe, F.; Niu, J. et al. "Contemporary prevalence and incidence of work disability associated with rheumatoid arthritis in the US." Arthritis Rheum. 2008; 59(4):474-80. DOI: 10.1002/art.23538.

Centers for Disease Control and Prevention. "Rheumatoid Arthritis." Atlanta, Georgia; updated July 17, 2017.