The British Journal of Rheumatology, Vol 37, 1324-1329, Copyright © 1998 by British Society for Rheumatology
K Eberhardt and E Fex
OBJECTIVE: To investigate the clinical course in early rheumatoid arthritis
(RA) patients followed prospectively, to relate course to outcome after 5
yr, and to try to identify prognostic features. METHODS: A total of 183
patients with definite RA and a mean disease duration of 11 months were
included. Of these, 75% were rheumatoid factor (RF) positive; 85% carried
the shared epitope, 32% on both alleles. Most patients were assessed every
6 months. Disability was evaluated with the Health Assessment Questionnaire
(HAQ) and radiographic findings according to Larsen. Remission was defined
in two ways: with the American Rheumatism Association (ARA) criteria and as
'no arthritis at least at one follow-up visit'. RESULTS: Twenty per cent
achieved ARA-defined remission periods of at least 6 months duration; 21
were spontaneous and 18 drug induced. Average length of remission was 20.5
months. The remission periods constituted 7% of follow-up for all patients.
Another 36% achieved remission according to the second definition. All 56%
were considered to have a relapsing- remitting disease pattern, in contrast
to the remaining 44% with a persistent disease pattern. More patients with
persistent disease were treated with disease-modifying anti-rheumatic drugs
(DMARDs) and had also received a larger number of different drugs. Outcome
after 5 yr regarding disability, joint inflammation and joint damage was
worse for patients with persistent disease. Neither ARA-defined remission
nor disease pattern could be accurately predicted. CONCLUSIONS: Long-term
ARA-defined remission was rare, constituting 7% of follow-up for the entire
cohort. For those 20% achieving remission, this period represented 34% of
their follow-up. A total of 56% had a relapsing- remitting disease pattern
and 44% had a persistent disease pattern. This classification had
prognostic implications with persistency being a bad prognostic sign.
ORIGINAL PAPERS
Clinical course and remission rate in patients with early rheumatoid arthritis: relationship to outcome after 5 years
Department of Rheumatology, Lund University Hospital, Sweden.
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