Basic trends and variability of rheumatoid arthritis evolution: long-term follow-up results

Abstract

Objective. To evaluate basic trends and variability of the course of rheumatoid arthritis, to reveal parameters of long-term prognosis. Material and Methods. 238 pts with RA (30 male, 208 female) were followed for (M±o) I5,5±6,4 years. They were investigated with standard clinical and laboratory methods. X-ray evaluation was done by Larsen method. Functional disability was investigated by Stanford Health Assessment Questionnaire. Results. At 2002 162 (68,1%) pts continue following up, 47 (19,7%) pts died, 29 (12,2%) patients were lost to follow-up. The activity of disease had a tendency to decrease, but X-ray changes and functional lesions developed. According to the dynamics of disease, 4 subgroups of pts were defined: 1st subgroup (16,3% of pts) with stable low activity and slow X-ray progression; 2nd subgroup (27,3%) with high initial activity and slow progression, 3rd subgroup (34%) with low or moderate activity and fast progression; 4th subgroup (22,5%) with persistent high activity of disease and fast X-ray progression. The subgroups differed significantly by severity of functional lesions, by frequency of secondary amyloidosis and by frequency of lethal outcomes. The main clinical signs of unfavorable course of disease were large joint involvement during first 2 years, the development of extraarticular changes during first 5 years and the development of joint erosions during first 2 years. Conclusion. Some simple clinical signs in the first years of disease (large joint involvement, the development of joint erosion and extraarticular lesions) allow to predict the course and long-term outcomes in the pts wit rheumatoid arthritis.