The Four Courses of Rheumatoid Arthritis, part 1

What are the four courses of RA? I had hoped that they would be appetizer, salad, entrée, and desert. But turns out they are not.

The names which I made up for them are Cyclone, Roller Coaster, Avalanche, and Tower of Terror. Maybe I live too close to Disney.

Historically speaking, there are four general courses which Rheumatoid Arthritis can take. These are the general patterns which have been observed over many decades. They describe the course that the disease will take. In spite of individual differences, patients generally fit into one of these categories.

On the day that you get your RA diagnosis, no one sends you an IM (instant message) to tell you which course the disease will choose. However, if you know about the typical patterns, you can probably identify yours within a few years. Arming yourself with information is always a good thing.

The first course of Rheumatoid Arthritis is pretty simple to understand. You get RA and then the RA goes away within six months. The pain and stiffness of RA does not lead to permanent damage. Neither the cause of the disease nor its disappearance can be fully explained medically. Only 5 to 10% of all those diagnosed with RA are in this category.

The second course of Rheumatoid Arthritis is more common – typical of about 15% of RA patients. The symptoms of RA come and go periodically. The peaks are commonly called flares. Periods between the flares (called remissions) seem more like life before RA. It becomes possible to exercise or do things that people who are in the midst of Rheumatoid Arthritis anguish cannot do. However, it is completely impossible to predict when the RA will return.

The third course of Rheumatoid Arthritis is the most common. This pattern is very similar to pattern number 2. The same pattern is seen with flares and remissions alternating. The difference is the damage which occurs because there is always some inflammation, even during the lulls. And the flares tend to worsen over the years.

About 75-80% of RA-ers will never have a complete remission. The third and fourth groups make up that number. Group three is the larger one.

Finally, the fourth course of Rheumatoid Arthritis is one in which there are not remissions. The disease only progresses. There is only flare. Or maybe there are no flares. Depends upon your viewpoint, I guess.