# Symptoms and stages of rheumatoid arthritis with organ involvement
Rheumatoid arthritis does not progress through fixed, clearly defined stages like some other conditions. Instead, the disease gradually shifts from an early phase — in which mainly one or a few joints become inflamed — to a phase with multiple joints and possible involvement of other organs. This tab describes how the disease typically unfolds and what complaints patients experience in different stages.
Early stage (first months to approximately 2 years after onset of first symptoms)
In the earliest stage, many patients feel stiffness in their hands, wrists or feet in the morning. This stiffness can last one to several hours and makes it difficult to perform small movements — such as turning on a tap or holding a bread knife. At the same time, joints become warm, swollen and painful, usually in hands and feet, but sometimes also in knees or shoulders.
**Joint complaints:**
- Pain that worsens after rest and improves with movement (typical of inflammation)
- Swelling and redness around the joints
- Warmth in the affected joints
- Limitation in bending and straightening fingers and wrists
- Fatigue that decreases as you move more
In this phase, many patients also have a general feeling of being unwell: slight temperature elevation, fatigue, possible weight loss and a general sense of malaise. This is due to the inflammatory response in the body.
**Daily life:** Cooking, eating, getting dressed, washing and work can become difficult. People describe that fine motor tasks (buttoning, writing, typing) take much more time and are more painful.
**Figures:** The average time at which diagnosis is made is often 3 to 6 months after first complaints begin. In this early stage, the chance of remission (quiet period, little to no inflammatory activity) is greater than later, especially when treatment is started early. Approximately 30% of patients achieve remission, and in 50% complaints are considerably reduced with modern treatment (source: EULAR guidelines and international cohorts, 2020–2024).
Stage with multiple joints and progression (year 1–5)
Without treatment, or if treatment does not work well, the joint inflammation spreads to more joints on both sides of the body. This is a hallmark of rheumatoid arthritis: usually both hands, both feet or both shoulders are affected simultaneously (symmetrical pattern).
**Joint complaints in this phase:**
- Pain and swelling in increasingly more joints
- Deformity begins to develop (especially in hands: lateral deviation of fingers, 'swan neck' deformities)
- Reduced strength in hands and arms
- Difficulty walking and standing due to pain in feet and ankles
- More pronounced morning stiffness (sometimes 2–4 hours or more)
**Possible organ involvement appears:**
- **Lungs:** Many patients develop a moist cough, shortness of breath or pain with deep breathing. This occurs due to inflammation of lung tissue (interstitial lung disease) or inflammation of the pleura. Up to 30% of patients with rheumatoid arthritis develop some form of lung involvement (source: international studies, 2020–2024).
- **Heart:** Inflammation of the pericardium (pericarditis) causes chest pain, especially with deep breathing or lying down. Some patients also develop heart rhythm disorders.
- **Eyes:** Dry eyes (Sjögren's syndrome) cause a sandy feeling. Serious is inflammation of the inner iris (uveitis) or the white of the eye, which causes redness and pain.
- **Gastrointestinal tract:** Vomiting, abdominal pain, diarrhea or constipation can occur. Some patients have food intolerance. This can be caused both by the disease itself and by side effects of medications.
- **Oral cavity:** Gum bleeding, teeth that feel looser or fall out prematurely. Inflammation in the body increases the risk of gum involvement.
- **General:** Increased fatigue, abnormal fever spikes, depressive feelings due to chronic pain.
**Skin and other signs:**
- Small, hard nodules under the skin (rheumatoid nodules, especially on elbows or fingers), present in approximately 20–30% of patients.
- Pale or blue-tinged fingers in the cold (Raynaud's phenomenon).
**Daily life:** This becomes considerably more complex. Many patients can no longer work full days. Household tasks require help. Some cannot drive safely, sports activities cease, social life is limited by pain and fatigue.
**Figures:** Without treatment, rheumatoid arthritis progresses to more joints and permanent damage in 70% of patients (source: classic natural history study, pre-DMARD era). With current treatment (biologics, JAK inhibitors), 40–50% of patients achieve remission or very low disease activity. The median survival of untreated patients is shorter than that of the general population, particularly due to cardiac involvement and infections, but this has improved dramatically with modern therapy (source: EULAR, Cochrane reviews, 2022–2024). Individual differences are substantial.
Stage with permanent joint damage and prolonged organ involvement (year 5 and beyond)
After years, many joints remain inflamed, even with treatment. The cartilage and bone are damaged and deteriorate; joint damage becomes visible on X-ray. Certain joints lose their normal shape and range of motion.
**Joint complaints:**
- Permanent deformity (crooked fingers, deviated wrists, enlarged joints)
- Reduced mobility (ankylotic condition — joints feel stiff and move barely at all)
- Chronic pain, even at rest
- Weakness in hands and arms; much more difficulty with fine motor tasks
- Difficulty with walking and standing; possible need for mobility aids
- Considerable fatigue that does not improve with rest
**Organ involvement evolves:**
- **Lungs:** Progressive pulmonary fibrosis (scarring of lung tissue) can lead to progressively lower blood oxygen and persistent shortness of breath on exertion. This makes everyday activities difficult.
- **Heart:** Increased risk of heart failure and heart attack; arrhythmias may worsen. Patients become fatigued more quickly and can tolerate less exertion.
- **Kidneys:** Some patients develop protein in urine or reduced kidney function, sometimes due to the disease, sometimes due to long-term use of certain medications (especially NSAIDs).
- **Blood:** Anemia (low red blood cells) due to chronic inflammation; low platelets may occur.
- **Eyes:** Retinal damage (especially with prolonged disease activity); dry eyes worsen.
- **Oral cavity:** Loss of more teeth; gum involvement progresses alongside rheumatoid arthritis.
- **General:** Infections occur more readily, as many treatment medications suppress the immune system. Tuberculosis, certain types of pneumonia, and other infections are risks.
**Daily life:** Many patients are functionally limited; some require full-time care. Work is often no longer possible. Social isolation is a risk as pain and fatigue make going out more difficult.
**Figures:** With long-standing rheumatoid arthritis without optimal treatment, joint damage visible on X-ray develops in approximately 50% within 2 years (source: classic studies). With modern treatment this is much lower — approximately 10–15% within 2 years (source: ATTRACTS, ATTRACT-II, EULAR consensus, 2020–2024). Patients with remission or very low disease activity have a better outlook for preserving joint function. The median disease activity over a lifetime varies greatly per person; some achieve sustained remission, others oscillate between periods of less and more severe symptoms.
Relationship with organ involvement: when does this escalate?
Organ involvement can occur at any stage, but typically occurs when rheumatoid arthritis is severe or long-standing. Some patients have cardiac involvement already in the early stage; others develop it only after years. Lung involvement is more common in patients who have been ill for longer and whose disease is poorly controlled.
**Signals that organ involvement is occurring:**
- New shortness of breath, especially on exertion
- Chest pain or heart palpitations
- Eye inflammation (redness, pain, vision deterioration)
- Abdominal complaints that do not resolve
- Persistent redness of eyes, dryness and itching
- Leg or foot swelling (especially on one side)
When to contact your healthcare provider?
Speak to your doctor or rheumatologist if:
- Joint symptoms suddenly worsen or spread rapidly
- New conditions appear (shortness of breath, chest pain, abdominal pain, eye redness)
- Fatigue becomes so severe that you can no longer do normal activities
- Your medications cause bothersome side effects
- You feel no improvement after a few weeks/months of treatment
- You develop high fever or feel seriously ill (may indicate infection)
- Your feet become so swollen or painful that walking is no longer possible
- Hands or arms feel weaker or can no longer perform certain strenuous tasks
_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._