Onset, Early Stages, and Prognosis of Rheumatoid Arthritis: A Clinical Study of 100 Patients with 11-year Follow-up

Abstract

One hundred patients with "definite" or "classical" rheumatoid arthritis were followed in a hospital clinic from within one year of the onset of the arthritis. The average interval between onset and first attendance was 3.7 months. Onset was commoner in the winter, transient prodromal symptoms being noted in 23, with possible precipitating factors in 14. The serum rheumatoid factor test was positive at some time in 88.The patients were reassessed between eight and 14 years later. Seventeen died during this period, five possibly as a result of the disease or its treatment.The remaining patients had improved as a whole in terms of the blood sedimentation rate, haemoglobin, titre of the rheumatoid factor test, and status of the disease, but there was an overall deterioration in functional capacity. Both the rheumatoid factor titre and the functional capacity at an earlier review could be directly correlated with the outcome, but other factors were not found to influence the ultimate prognosis.

The good initial response to therapy with a combination of traditional disease‐modifying antirheumatic drugs is sustained over time: The eleven‐year results of the Finnish rheumatoid arthritis combination therapy trial

“…There are few truly long-term (Ն10 years) followup studies on early RA that include clinical outcomes. Most of these studies have neither a definite nor an active treatment protocol, and the results can be considered to represent the course of conservatively treated RA (20)(21)(22)(23)(24).…”

When does rheumatoid disease start?

“…With increasing knowledge of the clinical, immunologic, and immunogenetic characteristics of the inflammatory arthritis syndromes, the concept of RA has emerged more clearly (12). In cohort studies, the R F test has been positive when first performed in the majority of cases, although a minority of patients have developed seropositivity only later in the disease (13)(14)(15).…”

Outcome in patients with early rheumatoid arthritis treated according to the “sawtooth” strategy

“…However, that cohort also included patients who disease was advanced at study entry. In another prospective study of 100 patients with early RA, 33% of 83 survivors were in functional class I11 or IV after a followup period of 11 years (32).…”

“…We found in the English-language literature 5 prospectively studied cohorts that included 50 or more consecutive clinic patients who had early RA at enrollment and were followed up for 2 years or more (24,25,(32)(33)(34)(35)(36)(37)(38). Male/female distribution, mean disease duration, frequency of RF seropositivity, and frequency of DR4 among the patients in these cohorts were similar, but the proportion of patients treated with SAARDs during the studies varied (Table 6).…”