Home To Message Boards Site Map 

How do you know the severity of RA?

I was wondering how you know the severity of your RA?

I have never really been told I have mild, moderate, or sever RA. I know a lot of people on here say their RD told them they have  blank   RA.

How do they determine who has what?

I am thinking I am probably moderate, but use to be mild before having my son.

This might help..

ACR Classification Criteria for Determining Progression of Rheumatoid Arthritis

Stage one
Early

1. No destrutive changes on roentgraghic examination
2. Radiographic evidence of osteoporosis may be present

Stage two
Moderate

1. Radiographic evidence of osteoporosis, with or without slight subcondral bone destruction; slight cartiledge destruction may be present

2. No joint deformaties, although limatation of joint mobility may be present

3. Adjacent muscle atrophy

4. Extraarticular soft tissue lesions, such as nodules and tenosynovitis may be present

Stage 3
Severe

1. Radiographic evidence of cariledge and one destruction, in addition to osteoporosis

2. Joint deformity such as subluation, ulnar deviation, or hyperextension, without fibrous or bony ankylosis.

3. Extensive muscle atrophy

4. Extraarticular soft tissue lesions, such as nodules and tenosynovitis may be present.

Stage 4
Terminal

1. Fibrous or bony ankylosis

2. Stage 3 criteria



ACR Classification Criteria of Functional Status in Rheumatoid Arthritis

Class I: Completely able to perform usual activities of daily living (self-care, vocational, and avocational)*

Class II: Able to perform usual self-care and vocational activities, but limited in avocational activities

Class III: Able to perform usual self-care activities, but limited in vocational and avocational activities

Class IV: Limited ability to perform usual self-care, vocational, and avocational activities




*Self-care activities include dressing, feeding, bathing, grooming, and toileting. Avocational (recreational and/or leisure) and vocational (work, school, homemaking) activities are patient-desired and age- and sex-specific.

Reference: Hochberg MC, et.al.: Arthritis Rheum 35:498, 1992.



Lynn

Thanks Lynn!

So... by those "guidelines" I am not moderate, I am severe. Glad I am not terminal... that would suck.

Man, you find out something new everyday.

When I go to my new RD, I am going to ask her what she thinks I am. She will probably say moderate/severe. Because when I am on Humira I am able to do much more, than when I am not on it.

Again Thank You, Lynn for helping me to figure this out.

joonie39276.4946180556You are welcome Joonie!

Lynn

Ok, so...if I have no erosions but was all of the way thru stage 3 and part of the way thru stage 4 - why did they say 'early onset severe'?  Because it happened in a space of 4 - 5 months?  Lynn, is there a time line involved anywhere?

Pip

Ok let's see if this helps anyone.

Severity of rheumatoid arthritis The severity of RA is based upon the severity of inflammation. Severity is classified as mild, moderate, or severe.

  Mild A person with mild RA has some of the following signs and symptoms:

  • Joint pain
  • Inflammation of at least three joints
  • An absence of inflammation in tissues other than the joints
  • Usually, a negative result on a rheumatoid factor test
  • An elevated ESR or CRP level
  • An absence of evidence of bone or cartilage damage on x-rays

Mild RA is initially treated with nonpharmacologic therapies and NSAIDs. Doctors usually recommend taking only one NSAID at a time and continuing to take the NSAID until inflammation has subsided.

If mild rheumatoid arthritis persists, a clinician may recommend adding a DMARD hydroxychloroquine (for less severe symptoms) or sulfasalazine or methotrexate (for more severe symptoms). If inflammation still persists, a clinician may recommend injecting the joint(s) with steroids. More aggressive therapy is needed if rheumatoid arthritis remains active or progresses despite three to six months of therapy.

  Moderate A person with moderate rheumatoid arthritis has some combination of the following signs and symptoms:

  • Between 6 and 20 inflamed joints
  • Usually, no inflammation in tissues other than the joints
  • An elevated ESR or CRP levels
  • A positive result on a rheumatoid factor test
  • Evidence of inflammation but no evidence of bone damage on x-rays

Moderate rheumatoid arthritis is initially treated with nonpharmacologic therapies and an NSAID plus a DMARD. The selection of a DMARD is based on the activity of the rheumatoid arthritis: hydroxychloroquine is often prescribed when activity is milder, sulfasalazine or methotrexate is often prescribed when activity is more moderate or severe.

Combinations of DMARDs are also used in moderate rheumatoid arthritis; the most frequently used combination is hydroxychloroquine, sulfasalazine, and methotrexate. Addition of a biologic response modifier may be suggested if inflammation persists despite full doses of one or more DMARDs.

A clinician may also recommend treatment with an oral steroid to relieve symptoms until the DMARD or combination therapy becomes effective. A clinician may recommend injecting steroids directly into one or a few joints to rapidly control inflammation.

  Severe A person with severe rheumatoid arthritis has one or more of the following signs and symptoms:

  • More than 20 persistently inflamed joints or a rapid loss of functional abilities
  • Elevated ESR or CRP levels
  • Anemia related to chronic illness
  • Low blood albumin level
  • A positive result on a rheumatoid factor test, often with a high level
  • Evidence of bone and cartilage damage on x-rays
  • Inflammation in tissues other than joints

Severe rheumatoid arthritis is initially treated with nonpharmacologic therapies and NSAIDs plus one or more of the DMARDs. Methotrexate is usually recommended first, with the initial dose of methotrexate increased if inflammation persists after six to eight weeks of treatment. Oral steroids may be added to treatment if severe rheumatoid arthritis is accompanied by symptoms of widespread inflammation, such as fever.

If these combined measures are ineffective, a clinician may recommend adding a second and perhaps third DMARD. There are many possible combinations of DMARDs, and it may require some trial and error to determine the combination that is most effective and has the fewest side effects.

The addition of biologic response modifiers to methotrexate is another approach for people who have not responded to methotrexate alone. Continued use of methotrexate along with an anti-TNF agent is usually necessary, although it may be possible to reduce the dose of methotrexate and still control the inflammation.

Stage of rheumatoid arthritis The stage of RA also affects the treatment of this condition. The stage is determined by the duration of the condition and the presence of inflammation. There are three general stages: recent-onset, established, and end-stage rheumatoid arthritis.

  Recent-onset A person with recent-onset RA meets the diagnostic criteria for the condition and has had evidence of inflammation for no more than six months. The treatment of recent-onset rheumatoid entails aggressive measures to slow or stop ongoing inflammation and protect the joints.

  Established A person with established RA has had evidence of inflammation for at least six to twelve months and may have irreversible joint damage and loss of function. The treatment of established rheumatoid entails aggressive measures to slow or stop ongoing inflammation and measures to slow or prevent additional changes in joint structure and function.

  End-stage A person with end-stage RA has little or no evidence of ongoing inflammation but often has significant joint damage with loss of function and deformity. The treatment of end-stage rheumatoid arthritis entails therapies that reduce pain and slow or prevent additional changes in joint structure and function.

Patients with end-stage RA may have pain due to joint damage rather than from inflammation. In this case, a clinician may recommend surgery to replace a damaged joint. However, some joints cannot be successfully replaced. For such joints, a surgical fusion to stop pain-producing movement of the affected joint may be recommended.

Thanks Joonie!

The only one I didn't have was #6 - and with my final PRA diagnosis - that could have been a while coming.  I even had the albumin!  Scared me to death, that one!

Still, one of my rheumy's suggested an ice pack!  I guess I was supposed to lie in a tub of it!

Pip

 

Copyright ArthritisInsight.com