[Course, follow-up and prognosis of rheumatoid polyarthritis]

Rheumatoid arthritis is the more frequent chronic inflammatory arthritis. It is a potentially severe disease which causes a functional handicap in nearly half the patients 10 years after the first clinical symptoms. However rheumatoid arthritis is a heterogenous disorder and no prognostic factors are universally accepted and validated. Clinical and biological data collected to date have provided a limited amount of information. Nevertheless, erythrocyte sedimentation rate, C reactive protein and rheumatoid factor titer appeared to be the more powerful available indicators or prognosis at the early stage of the disease. Recent studies strongly suggests that some autoantibodies and mainly genetic markers (HLA-DRB1 alleles) could be correlated with disease severity. Consequently, it would appear possible to distinguish immunogenetically homogeneous subpopulations of patients with rheumatoid arthritis. Serum concentrations of specific cartilage and bone molecules reflecting tissue turnover and metalloproteinases could correlate to rate of joint destruction. Finally a combination of the most pertinent markers could determine a "score of severity" of the disease.