Course and prognosis of early rheumatoid arthritis

Lessons learned from a 20 year prospective study of 100 Rheumatoid Arthritis (RA) patients are considered. Forty six had died and the causes of death are discussed and correlations with early features; the findings in the survivors and the patterns of the course of arthritis and treatment are described. A loss of life expectancy was observed: the 9 patients whose deaths were due to RA or its systemic complications, died some 15 years prematurely; the 8 in whom RA contributed to death died some 10 years prematurely and in the 29 in whom death was unrelated to RA, death was premature by about 5 years. Already after 1 year of arthritis the functional capacity was reduced in those patients who later died due to RA or in whom RA or its treatment contributed to death. The men died earlier than the women and overall mortality in men was higher despite a younger age at onset. Patients with persistently high ESR and strong seropositivity for rheumatoid factor also did badly. Of the patients, who had died, the functional capacity at last review before their deaths was noted. It appears that already 1-8 years before their deaths 35% of the patients were confined to chair or bed (Steinbröcker grade IV) and 24% markedly restricted (grade III). These figures show that prognosis of RA patients referred to a rheumatologist is probably worse than generally suggested. Rheumatoid arthritis is a severely disabling and potentially lethal disease.