Prognosis

Rheumatoid arthritis follows a very unpredictable course. Most patients have relapses and remissions.

• within 2 years of diagnosis, patients usually experience moderate disability, and after 10 years 30% are severely disabled
• approximately one third of patients cease work because of the disease
• life expectancy in patients with RA is also reduced. For example, a 50-year-old woman with RA is expected to die 4 years earlier than a 50-year-old woman without RA.

Some of the increased mortality is caused by gastrointestinal bleeding related to long-term use of NSAIDs, by infections potentiated through chronic use of steroids, and by the development of reactive amyloidosis, particularly in those with protracted severe disease.

For patients in remission or with low disease activity who are taking biological agents, studies suggest that discontinuing the biological agents leads to an increased risk of losing remission or low disease activity and an increased risk of radiographic progression. (2)

Reference:

1. Wolfe F, Rasker JJ, Boers M, et al. Minimal disease activity, remission, and the long-term outcomes of rheumatoid arthritis. Arthritis Rheum. 2007 Aug 15;57(6):935-42.
2. Henaux S et al. Risk of losing remission, low disease activity or radiographic progression in case of bDMARD discontinuation or tapering in rheumatoid arthritis: systematic analysis of the literature and meta-analysis. Ann Rheum Dis. 2018 Apr;77(4):515-22.