Rheumatoid arthritis natural history
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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