Rheumatoid arthritis (RA) is a chronic, autoimmune inflammatory. For rheumatoid arthritis, immune dysfunction leads to painful, progressive disabling arthritis. Rheumatoid arthritis is a systemic disease and can affect internal organs including eyes, lungs, heart, muscles, skin and blood vessels.
If undiagnosed or untreated it can effectively lead to a substantial loss of mobility due to pain and joint destruction. Roughly 60% of RA patients are unable to work 10 years after the onset of their illness.
So what factors which determine a poor outcome?
Of course, late diagnosis is the main reason. There is a narrow window of opportunity during the First 3 to 6 months of illness, in which aggressive treatment can slow or even stop the progression of the disease. However, if a patient is not treated in this period, the probability is high that they have already experienced some degree of joint damage and deformities.
When a patient is first seen, there are other factors that point to a poorer prognosis.
First, patients meet the criteria of the American College of Rheumatology for rheumatoid arthritis (RA) have a poorer prognosis than those who do not. These criteria have been developed and validated and are known by rheumatologists who see patients with RA. They include:
• Morning stiffness of a 1-hour
• arthritis involving more than 3 joints
• arthritis affecting the hands
• symmetrical polyarthritis
• Rheumatoid nodules
• Rheumatoid factor
• X-ray changes
Next the criterion is the presence of joints swollen and tender. Obviously, more joints are inflamed the situation. In general, if a patient has more than eight tenders and eight joints swollen to the presentation, their prognosis is worse.
Clinical signs pointing to the presence of internal organ involvement suggest early poor prognosis. For example, a patient presenting with eye or lung disease because of their rheumatoid arthritis, early have poor vision. The presence of vasculitis, an inflammation of blood vessels is also a good indicator of a poor result. Patients who do rheumatoid nodules were also aggressive disease, as a rule.
Patients are sometimes asked to complete a Health Assessment Questionnaire (HAQ). This is a standard form that asks patients about their ability to function with activities of daily living. The worst of the score, the more prognosis.
The results of laboratory tests can also point to whether a patient has a poor prognosis.
Patients who are at very elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) have a poor prognosis. ESR and CRP tests are used to measure the amount of inflammation a patient has.
High levels of rheumatoid factor, an antibody that is found in 80 percent patients with RA points to a worse disease. Another type of anti-cyclic citrullinated peptide (anti-CCP) antibodies are present in about 55% of patients with early rheumatoid arthritis and has been prepared to predict the development and progression of erosions in the first 2 years of the disease (Forslind K, et al. Ann Rheum Dis. 2004; 63:1090-1095).
Erosions are areas of cartilage and bone destruction seen on radiography.
A recent study has shown that some patients who are negative for RF but who have high levels of anti-CCP antibodies are also risk of developing erosions (Bukhari M, et al. Arthritis Rheum 2007 56: 2929-2935).
A note: if erosions are seen on X-Ray, the cat is out of the bag. An earlier detection of inflammation and erosion can be seen using magnetic resonance imaging (MRI) and ultrasound. These should be used in evaluating patients rather than x-ray.
So why the fixation on prognosis? We now know that patients with poor prognosis associated with rheumatoid arthritis have a lifetime much shorter. The lifetime is shortened associated with an increased risk of lymphoma, an increased risk of cardiovascular events such as heart attack and stroke and the inability gradually leading to an inability to perform activities of daily living.
What can you do as a patient?
Make sure if you have RA or suspect you have RA, see a rheumatologist as soon as possible … and make sure rheumatologist is aggressive in making treatment decisions. Treatment aggressive is the key to change the outcome of the disease from a poor prognosis with a good prognosis.
About the Author:
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info:
Walking Marathons and Rheumatoid Arthritis
[affmage source=”ebay” results=”25″]rheumatoid arthritis prognosis[/affmage]
[affmage source=”amazon” results=”5″]rheumatoid arthritis prognosis[/affmage]
[affmage source=”overstock” results=”25″]rheumatoid arthritis prognosis[/affmage]
[affmage source=”cj” results=”25″]rheumatoid arthritis prognosis[/affmage]
[affmage source=”clickbank” results=”10″]rheumatoid arthritis prognosis[/affmage]