Rheumatoid arthritis severe in 29% after 20 years

July 19, 2002

Last Updated: 2002-05-27 13:00:22 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Approximately 3 out of 10 patients with

rheumatoid arthritis will develop the most severe form of the disease over a

20-year period, according to Finnish researchers.

" The large majority in this (group) did not develop severe disease, " Dr.

Klippel, medical director of the Arthritis Foundation, remarked in an

interview with Reuters Health. " This study will provide a benchmark to

compare future follow-up studies of patients treated very differently. "

In the study, Dr. Juha K. Jantti and colleagues at the Rheumatism Foundation

Hospital in Heinola, Finland followed 103 patients with rheumatoid

factor-positive arthritis. Rheumatoid factor is a type of antibody found in

the blood of about 70% of rheumatoid arthritis patients. Those with more

severe disease generally have such antibodies.

At the beginning of the study, treatment was restricted to four drugs, while

after 1982 doctors had additional drugs to treat the patients, including

sulfasalazine and methotrexate. However, most patients continued to be

treated with no more than one drug at a time.

The investigators observed a disease progression of about 2% to 3% per year

in terms of the joint destruction. By the end of the study, two patients had

the maximum score in terms of joint destruction, while 24 (23%) had high

scores.

Combining these results with other tests of disease progression, Jantti and

colleagues conclude that the " 20-year incidence of severe rheumatoid

arthritis was 29% (30/103). " People with the most severe disease usually had

at least three large joints, such as the hip, knee or shoulder, surgically

replaced.

Klippel noted treatment has changed over the last decade. Among other

developments, there is now an emphasis on early diagnosis and treatment with

disease-modifying drugs, or those that actually slow the progress of the

disease rather than just treating the symptoms.

" It will be interesting to see if those treatment changes will lead to

better outcomes, " he said.

Rheumatoid arthritis is an autoimmune disease in which the body's defenses

attack its own tissues. It is more common in women, tends to strike between

the ages of 36 and 50, and results in a chronic destruction and deformity of

the joints. Smoking, high cholesterol, being overweight and certain dietary

factors have also been linked with a higher risk of the disease.

The Journal of Rheumatology 2002;29:688-692.

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