Course and Prognosis in Rheumatoid Arthritis: A Further Report

Abstract

Nine yrs. after discharge from the hospital, 20.5% of 200 patients with rheumatoid arthritis were without significant residual disability, 41% were moderately incapacitated, 27% were more severely crippled, and 11.5% had become entirely dependent on others. The death rate among the group over the years was higher than in the general population at all ages and in both sexes, but causes of death did not differ from the expected pattern. Mortality was highest among those most severely affected by the disease. Between discharge from hospital and the first assessment 2 yrs. later the overall pattern was one of improvement. Then there was a gradual but progressive deterioration in the functional status of the group as a whole, due in part to increasing age and degenerative changes in previously damaged joints. The disease remained moderately active in the majority of patients throughout the period of observation, but the capacity for useful employment was well maintained among the survivors. The prognosis was best in those patients in whom the onset was acute and who were admitted to the hospital within 1 yr. of onset. Age and sex did not exert any direct influence. The functional capacity of the individual patient on discharge from hospital provided a fairly reliable index of future progress. Those patients in whom the disease was rated as inactive on at least 1 occasion during the survey fared distinctly better than those whose disease remained active throughout. The results of the sensitized sheep cell test were significantly related to prognosis. The presence of nodules was associated with more severe forms of the disease. Treatment in addition to the basic regimen gave no additional benefit. Maintenance or loss of morale was intimately related to the degree of disability. The groups which showed the greatest initial improvement were those whose musculature was most efficient-the young rather than the old, men rather than women and manual rather than sedentary workers. This suggests that benefit from treatment was due to the physical measures used and not so much to a reduction in disease activity.