Ten year outcome in a cohort of patients with early rheumatoid arthritis: health status, disease process, and damage

Abstract

Objective: To investigate outcome as measured by health status, disease process, and damage in an unselected group of patients with early rheumatoid arthritis (RA) monitored prospectively for 10 years and to search for prognostic factors.

Patients and methods: 183 patients with RA with disease duration <2 years were assessed annually at a team care unit. Health status was measured by the Health Assessment Questionnaire (HAQ) and functional class. Disease process was assessed by clinical and laboratory measures of disease activity and evaluation of disease course. Damage was quantified as occurrence of major extra-articular manifestations and need for large joint replacements. Possible predictive factors were evaluated by logistic regression analyses.

Results: 168/183 patients completed the entire follow up period. Of all 183 patients, 137 (75%) had been treated with disease modifying antirheumatic drugs and 84 (46%) with low dose oral glucocorticoids. After 10 years 158 patients (94%) managed daily life activities independently (functional class I-II). As measured by the HAQ 20% had almost no disability, 28% were mildly disabled, and 10% were seriously disabled. Median HAQ score had increased from 0.8 to 1.1 (p<0.001). Disease activity was significantly reduced. 133 patients (79%) had a relapsing remitting disease course and 30 patients (18%) were in remission as defined by the American College of Rheumatology criteria. Thirty patients (17%) had undergone large joint replacements. Fifteen patients (8%) had developed major extra-articular complications. The HAQ score during the first three months predicted disability at 10 years with an odds ratio of 13.4.

Conclusions: Prospective studies such as this give important knowledge of the variable long term prognosis of RA and provide necessary background information for clinical trials of new treatment modalities.

Figure 1

Functional class distribution according to Steinbrocker at study start and years 1, 5, and 10.

Figure 2

HAQ and VAS pain at the study start and years 1, 5, and 10. The box plots show the median and 10th, 25th, 75th, and 90th centiles.

Figure 3

Distribution of HAQ scores after 10 years.

Figure 4

Active joint count and ESR at the study start and years 1, 5, and 10. The box plots show the median and 10th, 25th, 75th, and 90th centiles.