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Objective: To explore baseline risk factors for productivity loss and work disability over 5 years in patients with early, active RA. Patients and methods: In the FIN-RACo trial, 195 patients with recent onset RA were randomised to receive either a combination of DMARDs with prednisolone or a single DMARD for 2 years. At baseline, 162 patients were working or available for work. After 5 years' follow up, data on sick leave and retirement were obtained from social insurance registers or case records. The cumulative duration of sick leaves and RA related disability pensions was counted for each patient. To analyse predictors of productivity loss, the patients were divided into four groups according to duration of work disability per patient year. Results: Patient's and physician's global assessment of RA severity >50 and HAQ score >1.0 were risk factors for extension of productivity loss (OR (95% (CI)

The follow-up results 1 to 11 years (mean 5 years) after resection arthroplasty of the forefoot or arthrodesis of the first metatarsophalangeal (MTP) joint performed on 100 patients (179 feet) with classical or definite rheumatoid arthritis are presented and analysed. The main indication for surgery was pain in the damaged and more or less luxated MTP joint. Resection arthroplasty of MTP joints II-V was performed from the plantar approach in 167 feet. The Keller or Mayo operation was performed on the first MTP joint in 129 feet. Arthrodesis of the first MTP joint was done in 17 feet. The proximal joint of the hallux was not treated in 33 feet. According to the subjective assessment, results after surgery were considered good by 49 patients (91 feet, 51%), fair by 44 (76 feet, 42%), and poor by 7 (12 feet, 7%). These 7 patients complained of persistent pain or a disabling deformity of the toes, or both. Although these results were generally satisfactory, the objective results were not good. At follow-up more than 50% of the patients had recidivistic callosities, a hallux valgus deformity, a dorsal dislocation and lateral deviation of the lesser toes, or radiologically observable bony proliferations of the distal ends of the metatarsals--or a combination of these. All patients in whom a proximal or interphalangeal joint of the hallux was surgically or spontaneously fused were satisfied: the stiff joint was painless on walking. When destruction of the first MTP joint is severe and painful, arthrodesis is recommended.

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Infections, especially respiratory and urinary tract infections, are frequent causes of death in RA patients. The high proportion of undiscovered infections as a cause of death highlights the diagnostic difficulty. With a decreasing number of autopsies being performed at present, greater numbers of infections may be under-reported.