What Happens

The course of rheumatoid arthritis is hard to predict. It usually progresses slowly, over months or years. In some people it doesn't get worse, and symptoms stay about the same. But in rare cases, symptoms come on rapidly, within days.

Symptoms can come and go. You may have times in your life when joint pain goes away on its own for a while. This is called remission.

If the disease progresses, joint pain can restrict simple movements, such as your ability to grip, and daily activities, such as climbing stairs. It is a common cause of permanent disability. But early treatment may control the disease and keep it from getting worse.

Rheumatoid arthritis is more likely to get worse when:

• A rheumatoid factor blood test is positive.
• A blood test for the antibody CCP (cyclic citrullinated peptide) is positive.
• The disease fails to respond to therapy.
• Bumps (nodules) form rapidly.
• Many joints are affected.
• X-rays show early loss of bone or cartilage.

Joint damage

The ongoing inflammation caused by rheumatoid arthritis affects the tissues that line joints. It causes a breakdown in cartilage and loosens ligaments and tendons that support the joints. The resulting joint destruction can lead to deformed joints.

The pain, stiffness, fatigue, and whole-body (systemic) symptoms of rheumatoid arthritis can be disabling. Over time, the deformity caused by the disease can lead to difficulty with daily activities. Specific joint problems may also occur later in the course of the disease.

Hands and wrists are the most common location for deformities. See a picture of the most common problems in the hands.

The feet are also often affected. See a picture of common problems in the feet caused by rheumatoid arthritis.

Inflammation of the knees, if not controlled by treatment, can cause erosion of cartilage and can later lead to the need for knee replacement surgery.

Rheumatoid arthritis can also damage the cervical spine, or neck. This damage can limit how easily you can move your neck. In rare cases, the damage can pinch a nerve or affect the spinal cord and cause numbness, pain, weakness, or paralysis in the arms or legs.

Other problems

In a small number of severe cases, the disease may damage other organs. It is common for people with rheumatoid arthritis to feel depressed. These feelings may be caused by pain and progressive disability.

Most women with rheumatoid arthritis can become pregnant and have a healthy baby.