[Follow-up and prognosis in chronic polyarthritis]

The spectrum of rheumatoid arthritis (RA) ranges from benign remitting manifestations to rapidly progressive forms with increased mortality. About 10% of the patients show an intractable rapidly progressive course associated with severe extraarticular manifestations. Within the first three years, 70% of the patients develop radiological erosions of the joints and 31% deformities of the hands. Life expectancy is shortened by 3-18 years. Particularly, infections are more frequent causes of death in RA compared with controls. Work disability occurs in about a quarter of the patients within the first three years of RA and in 43-85% after eight to ten years. The ratio of direct to indirect costs is 1:3 in RA. Preliminary data show that regular rheumatological treatment leads to a marked reduction in indirect costs caused by production loss. The most important early indicators of an unfavourable disease course are the large number of swollen joints, early severe functional impairment, highly elevated laboratory markers of inflammation and rheumatoid factor. Knowledge of the current data regarding the course and prognosis of RA are helpful for assessment of the disease for insurance purposes.