In-patient treatment for active rheumatoid arthritis: clinical course and predictors of improvement

The objective was to determine the clinical course and predictors of clinical response in patients with rheumatoid arthritis (RA) who are hospitalized for active disease and functional deterioration. Sixty-three patients who were admitted to a rheumatology clinic for multidisciplinary treatment were prospectively evaluated at 2-weekly intervals. During the admission period, which lasted for a mean of 47 +/- 24 days, patients improved significantly according to variables of disease activity, functional status and emotional status. The change in the variables appeared to be linear with time. Twenty-seven patients (43%) fulfilled the Paulus 20% criteria for clinical response during treatment. A long disease duration, a high Larsen erosion score, a high level of disease activity at admission and the institution of a disease-modifying anti-rheumatic drug within 3 months before admission were associated with a clinical response. In patients hospitalized for active disease, improvement appeared to be linear with time during admission. Patients with long-standing, destructive disease and a high level of disease activity improved most during hospitalization.