Background Rheumatoid Arthritis (RA) is a progressive disease and is characterised by increased work disability, functional declines and radiographic damages. To prevent irreversible joint damage, Disease Modifying Antirheumatic Drugs (DMARDs) and recently available biologics should be given as soon as possible. Prospective long-term studies are difficult to organise and may have a minimal relevance for current clinical practice at the end of the study.
Objectives To examine retrospectively the long-term outcome of patients with RA in Austria.
Methods 81 indoor patients with seropositve RA (RA+) and seronegative RA (RA-) completed a standardised clinical and laboratory blood examination 3 ? 8× between 1978 ? 1999. The course of the disease was assessed by determining of Disease Activity Score (DAS), 28 Joint Count (28JC), 30 Swollen Joint Count (30SJC), Proximal Interphalangeal joint score (PIP), Ritchie Index, Stoke Index, Steinbrocker stage and Larson score.
Results Over 21 years with a mean duration of follow up of 10 years we observed a statistically significant improvement of PIP, of Ritchie Index, of Stoke Index and of DAS. Steinbrocker stage and Larson Score increased significantly. With respect to DMARDs we noted that a high percentage of the patients did not receive any DMARDs within the first two years of disease. From all used drugs Methotrexate (MTX) was continued much longer and was the preferred DMARD since the early nineties. Referring to extraarticular manifestations the most frequent was Sicca Syndrome in relation with positive Antinuclear Antibodies (ANA). We found two cases of vasculitis and one case of lung fibrosis; however we did not find a case of amyloidosis.
Conclusion In our long-term follow up a change of treatment with rather weak DMARDs at the onset of the disease to a more aggressive treatment within the last decade was remarkable. With respect to the significant increase of Steinbrocker stage and Larson score as well an early aggressive therapy is however required With respect to the association of ANA and extrarticular manifestations elevated ANA should give rise for an exact organ screening. The development of predicting factors for the outcome of patients with RA would be helpful to refer patients to specialist care as soon as possible.
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