Influence of prognostic features on the final outcome in rheumatoid arthritis: A review of the literature

doi:10.1016/0049-0172(88)90013-3

Seminars in Arthritis and Rheumatism

Volume 17, Issue 4, May 1988, Pages 284-292

https://doi.org/10.1016/0049-0172(88)90013-3 Get rights and content

Abstract

The literature on prognostic features on the final outcome in RA is reviewed. It is generally agreed that female sex and a positive RF are variables indicating a poor prognosis. Long-standing increased ESR and CRP values, decreased Hb, or the appearance of subcutaneous nodules are indicators of a less favorable clinical course. No conclusions can be drawn regarding other factors due to the incomplete and heterogeneous study designs.

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Cited by (155)

Sarar cohort: Disease activity, functional capacity, and radiological damage in rheumatoid arthritis patients undergoing total hip and knee arthroplasty
2015, Revista Brasileira de Reumatologia
Citation Excerpt :
Similarly to this study, other groups have found no correlation between the positivity or titers of RF with functional capacity and disease activity.19,20 The association between RF positivity and radiographic progression is known, especially in patients with early disease21,22 but how the joint damage accumulates over decades is not known. In this study, there was no independent correlation between RF and SENS, but patients of an average of 20 years of disease onset with many accumulated joint damage were evaluated.
The Sarar cohort consists of patients with rheumatoid arthritis and juvenile idiopathic arthritis who underwent hip or knee arthroplasties at hospital SARAH-Brasília. The objective of this study was to evaluate clinical and laboratory factors associated with disease activity, functional capacity and radiological damage in rheumatoid arthritis patients, participants in this cohort.
Cross-sectional study, with data collection achieved from medical records review.
Thirty-two patients were included, with a mean time of disease onset of 240 months. Nineteen patients underwent total knee and 17 total hip arthroplasty. There was a positive correlation between maximum dose of methotrexate and Clinical Disease Activity Index (R = −0.46, p = 0.011), and a negative one with Simplified Erosion and Narrowing Score (R = −0.58, p = 0.004). Simplified Erosion and Narrowing Score values were higher in patients with rheumatoid factor (p = 0.005) and anti-cyclic citrullinated peptide antibody 3 positivity (p = 0.044), in those with higher rheumatoid factor (p = 0.037) and anti-cyclic citrullinated peptide antibody 3 (p = 0.025) titers, and lower in patients with family history of rheumatoid factor (p = 0.009). Health Assessment Questionnaire values were higher in older patients (p = 0.031). In multiple linear regression, only “maximum dose of methotrexate” and “family history” remained with significant association with Simplified Erosion and Narrowing Score (r² = 0.73, p < 0.001 for both variables). In the model evaluating “Clinical Disease Activity Index” only “maximum dose of methotrexate” remained significantly associated (r² = 0.35, p = 0.016).
In the Sarar cohort, clinical and laboratory factors were related to disease activity, functional capacity and radiological damage, similar to studies evaluating patients with lower disease duration.
A coorte Sarar é composta por pacientes portadores de artrite reumatoide (AR) e artrite idiopática juvenil (AIJ) submetidos a artroplastias de quadril e joelho no hospital SARAH-Brasília. O objetivo deste estudo foi avaliar fatores clínicos e laboratoriais associados à atividade de doença, capacidade funcional e dano radiológico em pacientes com AR, participantes dessa coorte.
Estudo transversal, com coleta de dados em revisão de prontuário.
32 pacientes foram incluídos, com tempo médio de início da doença de 240 meses. Dezenove pacientes foram submetidos a ATJ e 17, a ATQ. Foi encontrada correlação positiva entre dose máxima de metotrexato (MTX) durante a evolução e Clinical Disease Activity Index (CDAI) (R = -0,46, p = 0,011) e negativa com Simplified Erosion and Narrowing Score (SENS) (R = -0,58, p = 0,004). Valores de SENS foram maiores nos pacientes com fator reumatoide (FR) (p = 0,005) e anticorpo anti-peptídeo cíclico citrulinado 3 (anti-CCP3) positivo (p = 0,044), nos com maiores títulos de FR (p = 0,037) e Anti-CCP3 (p = 0,025) e menores nos pacientes com história de familiar de AR (p = 0,009). Valores de HAQ foram maiores em pacientes mais idosos (p = 0,031). Na regressão linear múltipla, somente “dose máxima de MTX” e “história familiar” permaneceram com associação significativa com SENS (r² = 0,73, p < 0,001 para ambas as variáveis). No modelo que avaliou “CDAI”, apenas “dose máxima de MTX” permaneceu com associação significativa (r² = 0,35, p = 0,016).
Na coorte Sarar, fatores clínicos e laboratoriais estiveram relacionados à atividade de doença, capacidade funcional e dano radiológico, semelhantemente a estudos que avaliaram pacientes com menor tempo de doença.
Characteristics of rheumatoid arthritis patients with concomitant hepatitis C virus infection
2011, Egyptian Rheumatologist
Citation Excerpt :
In the studied patients, the frequencies of RF and ANA were not statistically significantly different between HCV-Ab positive and -negative RA patients. A longer disease duration in RA is associated with more structural damage and loss of mobility [37]. This was confirmed in the present study where increasing disease duration was significantly associated with higher frequency of deformities, erosive arthritis and modified Larsen’s scores (p < 0.001, p = 0.003, p = 0.002, respectively).
Hepatitis C virus (HCV) is frequently associated with rheumatic autoimmune manifestations including rheumatoid-like arthritis.
This work is aimed to study the impact of concomitant HCV infection on rheumatoid arthritis (RA) patients.
110 RA patients (mean age 44.6 ± 12.7, disease duration 7.92 ± 6.56 years) were included. HCV infection was diagnosed by HCV-antibody (HCV-Ab) and polymerase chain reaction. Disease activity was assessed using the disease activity score 28 (DAS28) and radiological damage by a modified Larsen method. Functional disability was assessed by the Modified Health Assessment Questionnaire (MHAQ).
HCV-Ab was detected in 20% and viremia in 12.7% of RA patients. HCV-Ab positive patients were significantly older (p < 0.001) and had a longer disease duration (p = 0.02). No differences were found between HCV-Ab positive and -negative patients in DAS28 and modified Larsen’s scores, however, HCV-Ab positive patients had a higher frequency of deformities (p < 0.005) associated with older age (p < 0.001) and higher MHAQ scores (p = 0.002), independent of age and disease duration. They also had a higher frequency of hepatomegaly (p < 0.001) and vasculitis (p < 0.001). Hepatomegaly was associated with older age (p = 0.004) and longer disease duration (p = 0.003) while vasculitis was associated with older age (p = 0.02).
Concomitant HCV infection in RA patients is associated with significant disability and comorbidities in the form of hepatomegaly and vasculitis. Hepatomegaly and vasculitis were associated with older age. Hepatomegaly was also associated with longer disease duration. Screening for HCV infection is recommended in Egyptian RA patients.
Established rheumatoid arthritis: clinical assessments
2007, Best Practice and Research: Clinical Rheumatology
Citation Excerpt :
With the increasing use of early interventions, longer-term treatment and aggressive drugs, it is very useful to be able to predict the disease course so as to assess the risk: benefit ratio of pharmacotherapy. Prognostic factors for progressive joint damage and disability have been the subject of extensive review.6,7 Probably most useful are those factors that are independent of disease activity, such as the presence of rheumatoid factor, antibodies to anticyclic-citrullinic peptide, and the so-called shared epitope of human leukocyte antigen (HLA)-DR7.
Clinical assessment of established rheumatoid arthritis (RA) can have several purposes. It can be used to evaluate prognosis, disease course or interventions at both the individual and the group level (i.e. in a clinical trial), over the short or long term. The instruments used for the different purposes are not always the same. For example, information on prognosis is very useful when assessing the risk:benefit ratio of early aggressive pharmacotherapy; however, established prognostic factors are currently of limited use in individual patients with established RA. As, at the individual patient level, disease activity, disability and joint damage have variable courses, the course of the disease should be evaluated regularly both with process (i.e. erythrocyte sedimentation rate, joint counts) and with outcome (i.e. radiological progression, sum of past process) measures. For the evaluation of interventions, ‘core sets’ of valid measures to assess disease activity, outcome and specific criteria for improvement are used; these can, to some extent, be useful in clinical practice.
Disease control and its associated factors in outpatients with rheumatoid arthritis
2023, Electronic Journal of General Medicine
Autoantibody testing in rheumatoid arthritis
2022, Manual of Molecular and Clinical Laboratory Immunology: 7th edition
Laboratory Interpretation of Rheumatic Diseases
2021, Skills in Rheumatology

View all citing articles on Scopus

¹: From the Department of Rheumatology, University Hospital Nijmegen, The Netherlands.

View full text

Influence of prognostic features on the final outcome in rheumatoid arthritis: A review of the literature

Abstract

Am J Med

Am J Med

Lancet

Hum Immunol

Lancet

Genetic markers in rheumatoid arthritis relationship to toxicity from d-penicillamine

J Rheumatol

HLA antigens and toxic reactions to sodium aurothiopropanol sulphonate and d-penicillamine in patients with rheumatoid arthritis

Ann Rheum Dis

HLA DR4 and rheumatoid arthritis in Japanese people

Ann Rheum Dis

Radiographic changes in early rheumatoid disease

Ann Rheum Dis

Survival in rheumatoid arthritis

Arthritis Rheum

Significance of the Waaler-Rose test, streptococcal agglutination, and antistreptolysin titer in the prognosis of rheumatoid arthritis

Ann Rheum Dis

Ten-year follow-up of rheumatoid arthritis

Lancet

Course and prognosis in rheumatoid arthritis

Ann Rheum Dis

Significance of positive tests for rheumatoid factor in the prognosis of rheumatoid arthritis

Ann Rheum Dis

Clinical interpretation of serological tests in rheumatoid arthritis

The development of disability in rheumatoid arthritis

Arthritis Rheum

Onset, early stages, and prognosis of rheumatoid arthritis: A clinical study of 100 patients with II-year follow up

Br Med J

Prognostic value of early features in rheumatoid disease

Br Med J

The clinical features of rheumatoid arthritis

JAMA

Observations on the clinical, chemical, and serological manifestations of rheumatoid arthritis, based on the course of 154 cases

Medicine (Baltimore)

Prediction of progressive joint damage in patients with rheumatoid arthritis receiving gold or d-penicillamine therapy

Ann Rheum Dis

The clinical features of elderly-onset rheumatoid arthritis

Arthritis Rheum

A clinical study of older age rheumatoid arthritis with comparison to a younger onset group

J Rheumatol

Rheumatoid arthritis in the aged

Geriatrics

Rheumatoid arthritis in old age

Isr J Med

La polyarthrite chronique evolutive apres l'age de 55 ans

Rev Rhum Mal Osteoartic

The onset of rheumatoid arthritis in the aged

J Am Geriatr Soc

Rheumatoid arthritis in the elderly

J Am Geriatr Soc

Clinical features in subacute rheumatoid arthritis in old age

Acta Rheum Scand

Benign rheumatoid arthritis of the aged

Br Med J

The clinical features of rheumatic infection in the old

Acta Med Scand

Die im Alter auftretende primar chronische polyarthritis

Z Rheumaforsch

Prognostic factors and diagnostic criteria in early rheumatoid arthritis

Scand J Rheumatol

Prognostic value of the type of onset of rheumatoid arthritis

Ann Rheum Dis

Presentation of rheumatoid arthritis and its relation to prognosis

Br Med J

Predictors of outcome at two years in patients with rheumatoid arthritis

J R Soc Med

Observations on the symptoms and signs of “early” rheumatoid arthritis in a prospective study

Acta Rheum Scand