Rheumatoid Arthritis Prognosis - How Soon Will Symptoms Worsen?

Questions About Prognosis Follow Rheumatoid Arthritis Diagnosis

Most newly-diagnosed rheumatoid arthritis patients have questions about how severe the disease will become and what they can expect for the future. They are anxious to know the prognosis associated with rheumatoid arthritis and what factors affect the prognosis. Patients ask:

• Will I face a mild or aggressive disease course?
• Will pain become unbearable?
• Is disability inevitable?
• Will I be able to work and take care of my family?

Determining the Prognosis

Initially, the prognosis for rheumatoid arthritis is based on how advanced the disease was when the patient was first diagnosed. Another factor considered is the age of the patient when first diagnosed or at disease-onset (when the disease began). Lastly, but probably most important is how active the disease is currently. Is rheumatoid arthritis in a flare, a remission, or is it managed well with treatment?

• About 10 to 20% of rheumatoid arthritis patients have sudden onset of the disease, followed by many years with no symptoms. This is considered a prolonged remission.
• Some rheumatoid arthritis patients have symptoms that come and go. Periods when there are few or no symptoms, which occur between flares, can last for months. This is referred to as intermittent symptoms of rheumatoid arthritis.
• The majority of rheumatoid arthritis patients have the chronic, progressive type of rheumatoid arthritis that requires long-term medical management.

Factors That Influence the Prognosis

Patients with the following factors are more likely to have a progressive and destructive form of rheumatoid arthritis and a severe disease course:

• Flares that are intense and last a long time
• Diagnosed very young and have had active disease for years
• Markers for inflammation are elevated on laboratory tests (elevated CRP and ESR)
• Significant joint damage already evident on x-rays when diagnosed
• Presence of rheumatoid nodules
• Test positive for rheumatoid factor or anti-CCP

Create an Action Plan With Your Doctor

If you and your doctor have assessed the factors that influence your prognosis, the next thing to do is periodically reassess those factors. At certain intervals, you should have x-rays, laboratory tests, and an examination to see if your physical results have changed.

If you find that your disease is very active, you are in a flare that seems unstoppable, lab results are worse, or x-ray evidence of joint damage is more pronounced, your treatment options should be reconsidered. You and your doctor may need a new plan of attack to slow or halt disease progression. Many of the new biologic treatments, often in combination with a traditional DMARD, have been successful for disease management.

To assess the effect of rheumatoid arthritis on how well you perform usual daily activities, you can take the Health Assessment Questionnaire (HAQ). By taking the HAQ periodically, you can determine if function is worsening. Again, you and your doctor may need to review your treatment options.
Download the HAQ (PDF)

_Sources:

ARAMIS: HAQ. Stanford University Medical Center. July 2003.
http://aramis.stanford.edu/HAQ.html

Arthritis Treatment: Early Is Best. Arthritis Today Magazine. May-June 2007.
http://www.arthritis.org/early-arthritis-treatment.php

Prognostic laboratory markers of joint damage in rheumatoid arthritis. Annals of the Rheumatic Diseases 2005;64:196-201. E Lindqvist et al.

Rheumatoid Arthritis Clinical Presentation. Johns Hopkins Arthritis Center. Alan Matsumoto, MD. Accessed 3/2/2008.
http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/rheum_clin_pres.html