Rheumatoid Arthritis May Become Milder With Time

June 5, 2002

Rheumatoid arthritis may grow milder over the very long term.

Eighty-eight patients with rheumatoid arthritis (RA) were followed for more

than 15 years to investigate very long-term clinical and functional outcomes

among patients of both office-based and hospital-based doctors. More than 25

percent believed they were in remission, and more than half had not seen a

doctor in the past six months. This despite none of the patients

experiencing burn-out of the disease in that time, and only six (7 percent)

met Pinals' remission criteria.

Yves Laborie and colleagues from the Rheumatology Department, Hotel-Dieu,

CHU Nantes, France, mailed a questionnaire relating to clinical outcomes

(active disease, remission, burn-out) and the Health Assessment

Questionnaire (HAQ) to 122 patients with RA of at least 15 years' duration.

Sixty-one of the patients had office-based doctors, and 61 had hospital

based.

Among the 88 patients who responded (72 percent), mean age was 63 ± 13

years, and mean disease duration was 20.1 ± 8.7 years.

Overall, 23 (26 percent) reported a current subjective remission with a mean

duration of 8.5 ± 5.9 months. Forty of the patients (46 percent) had a

history of arthroplasty (knee or hip in 29 [33 percent]).

Of 34 nonrespondents, seven had died, generally in their 70s. In four, cause

of death was infection or complications related to immobility.

In the 27 (nonrespondent) survivors, disease activity was considered minimal

by either the doctors or the patients. Eleven of these patients (41 percent)

believed they were in remission, and mean time since the last doctor visit

was 3.9 years.

Although functional outcomes varied widely across patients, they were

acceptable overall. The favourable effects of surgery were held to be at

least partly responsible for this.

Finally, the study found there were no differences between office-based and

hospital-based doctors in patient functional outcome.

Joint Bone Spine 2002;69:181-8

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