10-year outcome in a cohort of patients with early RA

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ls of the Rheumatic Diseases 2002;61:1055-1059

© 2002 by ls of the Rheumatic Diseases

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EXTENDED REPORT

Ten year outcome in a cohort of patients with early rheumatoid

arthritis: health status, disease process, and damage

E Lindqvist, T Saxne, P Geborek and K Eberhardt

Department of Rheumatology, Lund University Hospital, S-221 85 Lund,

Sweden

Correspondence to:

Dr E Lindqvist, Department of Rheumatology, Lund University, Hospital,

S-221 85 Lund, Sweden;

elisabet.lindqvist@...

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.

http://ard.bmjjournals.com/cgi/content/abstract/61/12/1055

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