A few days ago I wrote a blog about the stages of grief one goes through when diagnosed with a chronic illness and how we are all on our own path of acceptance. Someone in the phase of acceptance has a different perspective on the disease than someone who is in the anger phase. Today, I want to talk about the stages and classification of rheumatoid disease in correlation to the post on grief and acceptance. These two factors: your level of acceptance of diagnosis and the stage & classification of your disease are important to be aware of as you relate to other RA patients in your journey of treatment.
RA can be staged and classed, but doctors rarely use staging & classing to describe RA and instead use degrees of disease such as: mild to moderate or moderate to severe. I’m not sure why doctors have stepped away from the staging of RA. Perhaps it is because so many people relate staging & classification to cancer. Most of us know that Stage IV cancer is terminal. I don’t think they want us to know that rheumatoid disease can be terminal as well. Another reason may be that we all don’t fit in perfect categories and the staging of RA is not as cut and dried as the staging for cancer. I am going to share with you the staging model and classifications for RA for your understanding; however, I do not recommend you try to pin your rheumatologist into a stage/class unless your want a defensive response. Again, rheumatologists will only classify you as mild/moderate or moderate/severe.
Per Mosby’s Medical Dictionary, Volume 4 (page 1369): There are four stages of rheumatoid disease. (See bottom of page for definitions of medical terminology.)
- Stage I, Early: 1) X-ray films show no evidence of destructive changes. 2) X-ray films may show evidence of osteoporosis.
- Stage II, Moderate: 1) X-ray films show evidence of osteoporosis, possibly with slight destruction of cartilage or subchondral bone. 2) Joints are not deformed, but mobility may be limited. 3) Adjacent muscles are atrophied. 4) Extraarticular soft-tissue lesions (as nodules and tenovaginitis) may be present.
- Stage III, Severe: 1) X-ray films show cartilage and bone destruction, as well as osteoporosis. 2) Joint deformity (such as subluxation, ulnar deviation, or hyperextension) exists but not fibrous or bony anklylosis. 4) Extraarticular soft tissue lesions (such as nodules and tenovaginitis) are often present.
- Stage IV, Terminal: 1) Fibrous or bony ankylosis exists in addition to all criteria listed for Stage III.
- Class I: No loss of functional capacity.
- Class II: Functional capacity impaired but sufficient normal activities despite joint pain or limited mobility.
- Class III: Functional capacity adequate to perform few if any occupational or self care tasks.
- Class IV: Patient confined to bed or wheelchair and capable of little or no self-care.
So, as you can see in reviewing the staging and classification for rheumatoid disease not everyone, maybe even you fit neatly into a category. If I were to try to apply this system to me, I’d say I’m Stage III, Class II bordering on Class III. My rheumatologist classifies my disease as moderate/severe which is a much easier, but broader category for my symptoms.
The point I am trying to make is that while we may all have disease that falls under the broad definition of rheumatoid disease, we are at different stages of acceptance of our illness, different stages of disease, and different classification of disease. One of the common things I see in online RA chat groups is the need for validation of symptomology and continual comparison of symptoms. This leads to confusion as responses come forth denying the same symptoms, confirming your symptoms, or warning you of advanced symptoms. The group of diseases under autoimmune disorders is so broad that it’s going to be rare for you to find someone that has the exact set of symptoms that you do. Just remember when you are chatting with a fellow patient in the Rheumatologists office or in face-to-face support group, or online support group that just because you don’t have the symptoms someone else has does not invalidate your diagnosis or make your symptoms insignificant. It’s hard enough knowing the general public, some medical team members, friends, and family do not understand this disease. We need to be aware that under the umbrella of rheumatoid disease we have as many similarities as we do differences! 🙂
I hope you’ve found this post to have helped you understand your disease a little bit better. God didn’t make us all the same. Our disease symptoms are not all the same. Although it’s great to discuss your symptoms, your feelings, and your diagnosis with other patients remember that you are a unique individual and your treatment plan should be geared toward your uniqueness. Only YOU know how you feel physically, mentally, emotionally, and spiritually.
Definitions of Medical terms:
- Osteoporosis – thinning of the bones resulting in loss of bone mass due to loss of calcium and bone protein.
- Subchondral bone – the layer of bone just below the cartilage in a joint.
- Atrophied – a wasting away or decrease in size.
- Extraarticular -outside the joint.
- Tenovaginitis – inflammation of the tendon sheath or the lining of the tendon.
- Ankylosis: immobility of a joint due to bone fusion.