Rheumatoid arthritis natural history: Difference between revisions
No edit summary |
No edit summary |
||
| (5 intermediate revisions by 3 users not shown) | |||
| Line 1: | Line 1: | ||
__NOTOC__ | |||
{{Rheumatoid arthritis}} | {{Rheumatoid arthritis}} | ||
{{CMG}} | {{CMG}} | ||
==Overview== | ==Overview== | ||
==Natural History== | ==Natural History== | ||
==Complications== | ==Complications== | ||
===Rheumatological=== | ===Rheumatological=== | ||
* | *Joint deformitites | ||
*[[Felty's syndrome]] | *[[Felty's syndrome]] | ||
*[[Sjögren's syndrome]] | *[[Sjögren's syndrome]] | ||
| Line 29: | Line 30: | ||
*[[Quadriplegia]] | *[[Quadriplegia]] | ||
===Orthopedic complications=== | ===Orthopedic complications=== | ||
*Erosion of the odontoid process and or/transverse ligaments in the cervical spine | *Erosion of the odontoid process and or/transverse ligaments in the [[cervical spine]] | ||
*[[Osteoporosis]] | *[[Osteoporosis]] | ||
*Atlanto-axial subluxation | *Atlanto-axial subluxation | ||
| Line 35: | Line 36: | ||
*[[Lymphoma]] | *[[Lymphoma]] | ||
*[[Anemia]] | *[[Anemia]] | ||
==Prognosis== | |||
The course of the disease varies greatly from patient to patient. Some patients have mild short-term symptoms, but in most the disease is progressive for life. Around 20%-30% will have subcutaneous nodules (known as rheumatoid nodules); this is associated with a poor prognosis. | |||
===Disability=== | |||
*Daily living activities are impaired in most patients. | |||
*After 5 years of disease, approximately 33% of patients will not be working | |||
*After 10 years, approximately half will have substantial functional disability. | |||
===Prognostic factors=== | |||
*Poor prognostic factors include persistent synovitis, early erosive disease, extra-articular findings (including subcutaneous rheumatoid nodules), positive serum RF findings, positive serum anti-CCP autoantibodies, carriership of HLA-DR4 "Shared Epitope" alleles, family history of RA, poor functional status, socioeconomic factors, elevated acute phase response (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), and increased clinical severity. | |||
== | ===Mortality=== | ||
Estimates of the life-shortening effect of RA vary; most sources cite a lifespan reduction of 5 to 10 years; the [[National Institutes of Health]] has estimated a lifespan reduction of 10 to 20 years.<ref>[www.nih.gov/about/researchresultsforthepublic/arthritis.pdf Rheumatoid arthritis prognosis]</ref> According to the UK's National Rheumatoid Arthritis Society, "Young age at onset, long disease duration, the concurrent presence of other health problems (called co-morbidity), and characteristics of severe RA – such as poor functional ability or overall health status, a lot of joint damage on x-rays, the need for hospitalisation or involvement of organs other than the joints – have been shown to associate with higher mortality". <ref>[http://www.rheumatoid.org.uk/article.php?article_id=112 Excess mortality in rheumatoid arthritis]</ref> Positive responses to treatment may indicate a better prognosis. A 2005 study by the [[Mayo Clinic]] noted that RA patients suffer a doubled risk of heart disease,<ref>[http://www.mayoclinic.org/news2005-rst/2654.html The second largest contributor of mortality is cerebrovascular disease. Increased risk of heart disease in rheumatoid arthritis patients]</ref> independent of other risk factors such as [[diabetes]], alcohol abuse, and elevated [[cholesterol]], blood pressure and [[body mass index]]. The mechanism by which RA causes this increased risk remains unknown; the presence of chronic inflammation has been proposed as a contributing factor. <ref>[http://www.hopkins-arthritis.org/news-archive/2002/cardiac.html Cardiac disease in rheumatoid arthritis]</ref> | |||
==References== | ==References== | ||
{{ | {{Reflist|2}} | ||
[[Category:Needs content]] | |||
[[Category:Aging-associated diseases]] | |||
[[Category:Arthritis]] | |||
[[Category:Autoimmune diseases]] | |||
[[Category:Diseases involving the fasciae]] | |||
[[Category:Rheumatology]] | |||
[[Category:Needs overview]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 13:36, 20 June 2016
|
Rheumatoid arthritis Microchapters | |
|
Diagnosis | |
|---|---|
|
Treatment | |
|
Case Studies | |
|
Rheumatoid arthritis natural history On the Web | |
|
American Roentgen Ray Society Images of Rheumatoid arthritis natural history | |
|
Risk calculators and risk factors for Rheumatoid arthritis natural history | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Natural History
Complications
Rheumatological
- Joint deformitites
- Felty's syndrome
- Sjögren's syndrome
Cardiac complications
Pulmonary complications
Eye complications
- Scleritis, and
- Subcutaneous nodules
Renal complications
Nervous system complications
Orthopedic complications
- Erosion of the odontoid process and or/transverse ligaments in the cervical spine
- Osteoporosis
- Atlanto-axial subluxation
Hematological complications
Prognosis
The course of the disease varies greatly from patient to patient. Some patients have mild short-term symptoms, but in most the disease is progressive for life. Around 20%-30% will have subcutaneous nodules (known as rheumatoid nodules); this is associated with a poor prognosis.
Disability
- Daily living activities are impaired in most patients.
- After 5 years of disease, approximately 33% of patients will not be working
- After 10 years, approximately half will have substantial functional disability.
Prognostic factors
- Poor prognostic factors include persistent synovitis, early erosive disease, extra-articular findings (including subcutaneous rheumatoid nodules), positive serum RF findings, positive serum anti-CCP autoantibodies, carriership of HLA-DR4 "Shared Epitope" alleles, family history of RA, poor functional status, socioeconomic factors, elevated acute phase response (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), and increased clinical severity.
Mortality
Estimates of the life-shortening effect of RA vary; most sources cite a lifespan reduction of 5 to 10 years; the National Institutes of Health has estimated a lifespan reduction of 10 to 20 years.[1] According to the UK's National Rheumatoid Arthritis Society, "Young age at onset, long disease duration, the concurrent presence of other health problems (called co-morbidity), and characteristics of severe RA – such as poor functional ability or overall health status, a lot of joint damage on x-rays, the need for hospitalisation or involvement of organs other than the joints – have been shown to associate with higher mortality". [2] Positive responses to treatment may indicate a better prognosis. A 2005 study by the Mayo Clinic noted that RA patients suffer a doubled risk of heart disease,[3] independent of other risk factors such as diabetes, alcohol abuse, and elevated cholesterol, blood pressure and body mass index. The mechanism by which RA causes this increased risk remains unknown; the presence of chronic inflammation has been proposed as a contributing factor. [4]
References
- ↑ [www.nih.gov/about/researchresultsforthepublic/arthritis.pdf Rheumatoid arthritis prognosis]
- ↑ Excess mortality in rheumatoid arthritis
- ↑ The second largest contributor of mortality is cerebrovascular disease. Increased risk of heart disease in rheumatoid arthritis patients
- ↑ Cardiac disease in rheumatoid arthritis