Rheumatoid arthritis causes pain and discomfort that are impossible to ignore. With the right treatment plan, some people achieve remission, meaning they have few symptoms and low disease activity. But rheumatoid arthritis progression can happen even after years of managing your condition.
Rheumatoid arthritis is a chronic inflammatory disorder that impacts the lining of the joints, causing pain and swelling, according to the Mayo Clinic. Left untreated, the disease can progress and damage your joints or spread to other tissues in your body, including your heart, lungs, eyes, kidneys, and blood vessels.
The good news is that there are medications available that can improve and even resolve symptoms entirely, putting you into remission, says Beth Wallace, M.D., assistant professor of internal medicine at the University of Michigan and staff rheumatologist at the VA Ann Arbor Healthcare Center. Being in remission means that you have very few tender or swollen joints and no markers of elevated inflammation in the blood. Some doctors may also use scans like MRIs and X-rays to confirm there’s no visible inflammation, Dr. Wallace says. When you’re in remission and have no signs of disease activity, doctors feel pretty confident that the disease is not progressing.
But for many people, controlling rheumatoid arthritis to the point of having zero symptoms or flares is really difficult. Finding the right treatment protocol is often a long journey. And even if treatment is working enough to where you live comfortably with very minor symptoms, you may experience long-term joint damage if you still have some degree of inflammation, says Karmela Chan, M.D., rheumatologist at Hospital for Special Surgery in New York City.
People who have a hard time controlling their rheumatoid arthritis with medications are at a higher risk of progression and need to be the most vigilant about tracking symptoms, Dr. Wallace says. That said, anyone with the condition should pay close attention to how they feel and talk with their physician about any changes in their symptoms or new health concerns even if they seem unrelated to rheumatoid arthritis.
Here are some signs to watch for that your rheumatoid arthritis may be progressing, despite treatment.
1. Your pain and swelling have returned.
For starters, pain is always a good indicator of rheumatoid arthritis progression, Dr. Chan says. “It’s especially telling if you start on medication and you get better, and then later on you start to develop pain again,” Dr. Chan tells SELF. However, some patients may have trouble noticing or admitting their pain has increased if it’s still at a bearable level, Dr. Wallace says. After you’ve experienced a lot of rheumatoid arthritis pain and finally got it to a tolerable place with medication, small increases may be a blip on your radar. Furthermore, Dr. Wallace says some individuals don’t want to acknowledge new pain if it’s minimal because it saves them from going through the process of figuring out a new treatment strategy.
But it’s never a good idea to ignore your pain, as it can signal that your body still has a moderate amount of inflammation or disease activity. And getting your condition under control and into remission will keep the disease from progressing and preserve your joints. Treating your arthritis quickly can prevent irreversible damage and allow you to do the things you love for years to come.
2. Your range of motion changes.
“Commonly, people will say their fingers don’t straighten anymore or they can’t bend or straighten them all the way,” Dr. Wallace says. “Their fingers don’t necessarily hurt more, but they don't work like they used to work." Any range of motion or function changes like these can indicate rheumatoid arthritis progression, even without accompanying pain or tenderness.
Most people with active rheumatoid arthritis have a limited range of motion in the joints most affected by the disease, Dr. Wallace says. For many people, this includes the joints in their hands, which makes it hard to do everyday things, like drink coffee. “A lot of people with active rheumatoid arthritis have problems with things like holding coffee cups, gripping steering wheels, chopping vegetables, things that require a tight grip,” she says. This is often worse in the morning and gets worse when a person is experiencing a flare.
Depending on your situation, your doctor may recommend using supportive devices, like finger splints, to correct mild deformities. In situations where you have scar tissue or your joint function is severely limited, surgery may be necessary to regain proper functioning, according to Merck Manual.
3. You change your habits or activities to accommodate your joints.
Be mindful of how you move and feel while doing various activities throughout the day, such as yoga, standing, or cooking. For example, are you suddenly making adjustments so that your hands feel comfortable while making dinner? Are you avoiding clothes with buttons because you can't button them? These subtle behavior changes can indicate rheumatoid arthritis progression, Dr. Chan says. “You might think that [these changes] are not a big deal because you can easily adjust how you do things and feel fine, but you want to bring that to your doctor’s attention,” she says.
Even if rheumatoid arthritis isn’t necessarily more painful, and the limitations are easy enough to work around, adjusting your treatment plan to address any underlying inflammation can help the disease from progressing.
4. You have pain and tenderness in new joints.
Typically, the joints that get worse during rheumatoid arthritis progression are the same joints that were most affected at the beginning of your diagnosis. “But people can develop changes in new joints that hadn’t been affected before,” Dr. Wallace says. So if you suddenly have chronic neck pain, then you may want to ask your doctor if it’s related to your rheumatoid arthritis. Generally, rheumatoid arthritis affects the smaller joints first, like those in the fingers and toes, and impacts larger joints like the knees, ankles, elbows, hips, and shoulders as it progresses, according to the Mayo Clinic.
Dr. Chan says it’s important that your doctor knows about any new joint symptoms. One of the ways your physician can monitor your rheumatoid arthritis is by counting how many swollen and tender joints you have during each visit, Dr. Chan says. It’s a sign the disease has progressed whenever new joints are added to the list.
5. Your joints look different.
Looking at your joints can help detect rheumatoid arthritis progression. Over time, rheumatoid arthritis can cause visible distortions as the condition damages your tissues and bones. There are various ways that your joints may look different. For example, your finger or wrist joints may deviate to the side and bend toward your pinky if you developed an ulnar deviation, Dr. Chan says. It’s worth notifying your doctor any time your joints look different because these structural changes could be a sign of rheumatoid arthritis progression, Dr. Chan says.
6. You develop new and unusual symptoms unrelated to your joints.
“Rheumatoid arthritis is a systemic disease, meaning it can affect multiple tissues in the body, not just joints,” Dr. Wallace says. According to the Mayo Clinic, about 40% of people with rheumatoid arthritis experience symptoms in other areas of the body beyond the joints. (The eyes, lungs, heart, skin, kidneys, and blood vessels are common areas that can become inflamed because of rheumatoid arthritis.) “A lot of people develop inflammation in these other areas later in the disease as it progresses,” Dr. Wallace notes. You may not always notice symptoms,, or even realize that a change in your eyesight or shortness of breath is in any way related to rheumatoid arthritis. This is why it’s really important to tell your doctor about any new symptoms or changes in your health, even if it seems unrelated. Uncontrolled inflammation in these areas can lead to more serious health impacts—like increasing cardiovascular disease risk, for example—so it’s important to keep your physician in the loop so it can be addressed, Dr. Wallace says.
It’s easy to think of these changes as no big deal. But being mindful of your pain levels, mobility, and overall health can help you spot the signs of rheumatoid arthritis progression. Understandably, experimenting with new medications can feel stressful, but finding a treatment plan that helps you feel your best will allow you to move and live better in the long term.
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