The Progression of Rheumatoid Arthritis

Reviewed by Michael W. Smith, MD, February 2006

Most people with rheumatoid arthritis experience some progression of their disease during their lives. Although there have been cases of remission without treatment, these are rare. So you're right to be concerned.

But there are treatments that can help, and each person responds to the disease differently. What can you expect? That depends on many factors.

• How advanced your rheumatoid arthritis is at the time you are diagnosed
• Your age at the time you are diagnosed
• How "active" your disease is

Each person's rheumatoid arthritis is unique, and the disease affects each person differently. Over the long term, though, there are a few common patterns.

• Long remissions. Remission means near-disappearance of symptoms without an actual cure. About 10% to 20% of people diagnosed with rheumatoid arthritis have a sudden onset of the illness, but then have no symptoms for many years, even decades.
• Intermittent symptoms. About 15% to 30% of people with rheumatoid arthritis have disease that waxes and wanes slowly. They have periods of low or no symptoms that can last months between flares.
• Progressive rheumatoid arthritis. Unfortunately, that leaves the majority of people, who have the most common and serious form of rheumatoid arthritis. Because it's progressive, it requires a long-term treatment plan and a coordinated medical team to manage the treatment.

How can you tell which kind of rheumatoid arthritis you have and whether it will progress? There is no easy way, but there are some general "road signs" that suggest you might have the progressive form of rheumatoid arthritis. You might have progressive RA if you:

• Have long duration or high intensity of disease activity (flares)
• Were diagnosed at a young age, which means the rheumatoid arthritis has more time to become active in your body
• Have rheumatoid nodules -- bumps under the skin that most often appear on the elbows
• Have active inflammation that shows up in tests of your joint fluid or in blood tests
• Had a lot of damage already on X-rays when you were diagnosed

What's the most important thing you can do to follow the progression of rheumatoid arthritis? See a rheumatologist. Your doctor will do a complete joint examination, lab tests, and X-rays to see if your disease has progressed.

At later visits, your doctor can recheck your joints, tests, and X-ray films and see if any further progression has occurred. If your rheumatoid arthritis is progressing, there are good treatment options to slow it down.

A "functional questionnaire" may also help you track the progression of your rheumatoid arthritis. The Health Assessment Questionnaire (HAQ) is a commonly used tool to keep track of rheumatoid arthritis progression, and it's available for free on the Internet.

1. Download the HAQ at aramis.stanford.edu/HAQ.html
2. Fill it out, get a copy in your medical record, and recheck it periodically. Your rheumatologist, or another member of your treatment team, will suggest a schedule.
3. Note any changes in your level of function and discuss them with your treatment team.

Don't overlook the affect your rheumatoid arthritis has on your mental health. If you are having trouble coping, seek help. Psychologists, social workers, and psychiatrists can help you deal with the struggle of living with the long-term uncertainty and limitations of rheumatoid arthritis.

There is good news for people with rheumatoid arthritis. Treatment is improving and, in many cases, can delay progression of this disease. What does this mean for you? Many experts believe that today's patients may have less progression in their lifetimes than patients of the past.

Next: Treating Rheumatoid Arthritis With Disease-Modifying Drugs (DMARDs)

SOURCES: Breedveld, F., Annals of the Rheumatic Diseases, January 2005; vol 64: pp 52-55. Harris, E., Kelley's Textbook of Rheumatology, 7th edition, W.B. Saunders, 2005. Krishnan, E., American Journal of Medicine, Oct. 1 2003; vol 115: pp 371-376. Lee D. The Lancet, Sept. 15, 2001; vol 358: pp 903-911.

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