[Factors predictive of severity in rheumatoid arthritis]

Rheumatoid arthritis (RA) is a very heterogeneous disease with multiple forms. Some are very mild with few or no overt lesions or joint deformations, others are very severe leading to rapid joint destruction and major functional handicap. The best therapeutic strategy for patients with early stage RA cannot be uniform, but must be adapted to each individual patient, depending on disease severity. This fact is becoming even more important with the development of new treatments which have had a major impact on therapeutic strategies. No prognostic factor has reached universal acceptance. There are however an increasing number of arguments allowing better recognition of prognosis during the early stages of the disease. High ESR, CRP, positive rheumatoid factor with a high IgM (and IgA) titer, the presence of one of the HLA DRB1*04 alleles associated with RA, and early development of radiological lesions are all factors of prognosis.