Rheumatoid Arthritis in a 10-Year Perspective, Outcome for Patients Followed from Early Disease
Abstract: Rheumatoid arthritis (RA) is characterized by persistent inflammation, progressive joint damage and disability. This thesis describes the outcome after 10 years in a cohort of 183 RA patients (116 women, 67 men) recruited 1985-89. The mean age was 51 years and symptom duration 11 months at inclusion. Standardized clinical, biochemical and radiographic assessments were performed annually. Health status, disease process, damage and mortality were evaluated and early factors predicting outcome were investigated. After 10 years: -94% preserved independence in daily life, 47% were mildly disabled, as evaluated by HAQ, however disability increased significantly. -18% were in remission, 17% had undergone large joint replacement and 8% had developed extra-articular manifestations. -Joint damage in hands and feet developed and progressed most markedly during the first 3 years and affected 96% of the patients. -Mortality was not increased. -Initial HAQ predicted disability after 10 years correctly to 70%, while remission, extra-articular manifestations and mortality were not predictable. -ESR, COMP, IgA-RF, anti-CCP and anti-IL-1alpha at inclusion were prognostic for future joint damage in an additive fashion. -In the disablement process, disease activity and joint damage contributed most to the development of body function impairments. Disease activity and body function impairments subsequently led to activity limitations (HAQ). The outcome has improved compared with earlier studies, especially for disability and mortality. Continued follow-up of these patients will provide information on the long-term consequences of RA and the cohort will be useful for the evaluation of novel prognostic markers.
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