“…In addition, many clinical and laboratory parameters including age at onset, disease duration [3,5,6,7], total joint count with tenderness and swelling [8,9,10,11], and presence of rheumatoid nodules [3,9,11,12,13,14], systemic manifestations, and radiological changes [3,8,15] may contribute to unfavorable prognosis. Finally, high erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values [7,8,11,14,16,17] and the rheumatoid``shared epitope'' may also in¯uence RA disease severity and outcome [18,19,20].…”