Rheumatoid arthritis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
The symptoms of rheumatoid arthritis usually develop in the third to fourth decade of life. Symptoms such as fatigue, small joint pain and morning stiffness are seen initially, the stiffness may last more than 1 hour. Complications of rheumatoid arthritis may involve various organ systems. Cardiac complications include pericarditis, congestive heart failure, endocarditis, and myocardial infarction. Pulmonary complications include pleurisy, alveolitis, pleural effusion, and pulmonary fibrosis. Rheumatological complications include joint deformities, Felty's syndrome, sjögren's syndrome, osteoporosis, and atlantoaxial subluxation. Ophthalmology complications include scleritis and keratitis. Renal complications include chronic renal failure from amyloidosis. Nervous system complications like peripheral neuropathy, quadriplegia, and mononeuritis multiplex may also be seen. Prognosis is generally good with early diagnosis and treatment. The 10-year disability rate of patients with rheumatoid arthritis is approximately 40%.
Natural History
- The symptoms of rheumatoid arthritis usually develop in the third to fourth decade of life. Symptoms such as fatigue, small joint pain and morning stiffness lasting more than 1 hour may be seen.
- If left untreated, patients with rheumatoid arthritis may progress to develop extra-articular manifestation.
Complications
The complication of rheumatoid arthritis are given below:[1][2]
Rheumatological
The rheumatological complications of rheumatoid arthritis include:
- Joint deformitites
- Felty's syndrome
- Sjögren's syndrome
Cardiac complications
The cardiac complications of rheumatoid arthritis include:
Cardiovascular disease
Paitents with RA are at increased risk of vascular disease.[3][4][5]
The degree of increase in risk is hard to estimate as meta-analyses of the cohorts note that many studies did not adjust for cardiovascular risk factors. This includes the meta-analysis by Dadoun[6] cited by the EULAR guidelines[7] and the meta-analysis by Aviña-Zubieta[8] cited by the American Heart Association[9].
Thus, while EULAR recommends multiplying cardiac risk in RA patients by 1.5, this does not seem supported by the analysis cited by EULAR.
Pulmonary complications
The pulmonary complications of rheumatoid arthritis include:[10][11][12]
Ocular complications
The ocular complications of rheumatoid arthritis include:
Renal complications
The renal complications of rheumatoid arthritis include:
Neurological complications
The neurological complications of rheumatoid arthritis include:[13][14]
Orthopedic complications
The orthopedic complications of rheumatoid arthritis include:[15]
- Erosion of the odontoid process and transverse ligaments in the cervical spine
- Osteoporosis
- Atlanto-axial subluxation
Hematologic complications
The hematologic complications of rheumatoid arthritis include:
Dermatological complications
The dermatological complications of rheumatoid arthritis include:[16][17]
- Splinter haemorrhages
- Periungual infarcts
- Leg ulcers
- Digital gangrene
- Pyoderma gangrenosum
Prognosis
- Prognosis is generally good with early diagnosis and treatment, and 10-year disability rate of patients with rheumatoid arthritis is approximately 40%.
Prognostic factors
- Poor prognostic factors are:[18][19]
- Insidious onset of symptoms
- Female sex
- Age less than 30 years
- HLA-DRB1*04/04 genotype
- High serum levels of autoantibodies
- Extra-articular symptoms
- Systemic symptoms
- Cigarette smoking
- Lack of formal education
- Lower socioeconomic status
References
- ↑ Young A, Koduri G (October 2007). "Extra-articular manifestations and complications of rheumatoid arthritis". Best Pract Res Clin Rheumatol. 21 (5): 907–27. doi:10.1016/j.berh.2007.05.007. PMID 17870035.
- ↑ Al-Ghamdi A, Attar SM (2009). "Extra-articular manifestations of rheumatoid arthritis: a hospital-based study". Ann Saudi Med. 29 (3): 189–93. PMC 2813651. PMID 19448378.
- ↑ Solomon DH, Karlson EW, Rimm EB, Cannuscio CC, Mandl LA, Manson JE, Stampfer MJ, Curhan GC (March 2003). "Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis". Circulation. 107 (9): 1303–7. PMID 12628952.
- ↑ Turesson C, McClelland RL, Christianson TJ, Matteson EL (January 2007). "Severe extra-articular disease manifestations are associated with an increased risk of first ever cardiovascular events in patients with rheumatoid arthritis". Ann. Rheum. Dis. 66 (1): 70–5. doi:10.1136/ard.2006.052506. PMC 1798415. PMID 16877533.
- ↑ Roman MJ, Moeller E, Davis A, Paget SA, Crow MK, Lockshin MD, Sammaritano L, Devereux RB, Schwartz JE, Levine DM, Salmon JE (February 2006). "Preclinical carotid atherosclerosis in patients with rheumatoid arthritis". Ann. Intern. Med. 144 (4): 249–56. PMID 16490910.
- ↑ Dadoun S, Zeboulon-Ktorza N, Combescure C, Elhai M, Rozenberg S, Gossec L; et al. (2013). "Mortality in rheumatoid arthritis over the last fifty years: systematic review and meta-analysis". Joint Bone Spine. 80 (1): 29–33. doi:10.1016/j.jbspin.2012.02.005. PMID 22459416.
- ↑ Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJ; et al. (2017). "EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update". Ann Rheum Dis. 76 (1): 17–28. doi:10.1136/annrheumdis-2016-209775. PMID 27697765.
- ↑ Aviña-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D (2008). "Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies". Arthritis Rheum. 59 (12): 1690–7. doi:10.1002/art.24092. PMID 19035419.
- ↑ Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS; et al. (2019). "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Circulation. 139 (25): e1082–e1143. doi:10.1161/CIR.0000000000000625. PMID 30586774.
- ↑ Bharadwaj A, Haroon N (October 2005). "Interstitial lung disease and neuropathy as predominant extra-articular manifestations in patients with rheumatoid arthritis: a prospective study". Med. Sci. Monit. 11 (10): CR498–502. PMID 16192902.
- ↑ Balbir-Gurman A, Yigla M, Nahir AM, Braun-Moscovici Y (June 2006). "Rheumatoid pleural effusion". Semin. Arthritis Rheum. 35 (6): 368–78. doi:10.1016/j.semarthrit.2006.03.002. PMID 16765714.
- ↑ Kim EJ, Collard HR, King TE (November 2009). "Rheumatoid arthritis-associated interstitial lung disease: the relevance of histopathologic and radiographic pattern". Chest. 136 (5): 1397–1405. doi:10.1378/chest.09-0444. PMC 2818853. PMID 19892679.
- ↑ Chang DJ, Paget SA (November 1993). "Neurologic complications of rheumatoid arthritis". Rheum. Dis. Clin. North Am. 19 (4): 955–73. PMID 8265831.
- ↑ Nadkar MY, Agarwal R, Samant RS, Chhugani SJ, Idgunji SS, Iyer S, Borges NE (February 2001). "Neuropathy in rheumatoid arthritis". J Assoc Physicians India. 49: 217–20. PMID 11225133.
- ↑ Laiho K, Kaarela K, Kauppi M (June 2002). "Cervical spine disorders in patients with rheumatoid arthritis and amyloidosis". Clin. Rheumatol. 21 (3): 227–30. PMID 12111629.
- ↑ Genta MS, Genta RM, Gabay C (October 2006). "Systemic rheumatoid vasculitis: a review". Semin. Arthritis Rheum. 36 (2): 88–98. doi:10.1016/j.semarthrit.2006.04.006. PMID 17023257.
- ↑ Charles CA, Bialy TL, Falabella AF, Eaglstein WH, Kerdel FA, Kirsner RS (July 2004). "Poor prognosis of arthritis-associated pyoderma gangrenosum". Arch Dermatol. 140 (7): 861–4. doi:10.1001/archderm.140.7.861. PMID 15262699.
- ↑ Agrawal S, Misra R, Aggarwal A (February 2007). "Autoantibodies in rheumatoid arthritis: association with severity of disease in established RA". Clin. Rheumatol. 26 (2): 201–4. doi:10.1007/s10067-006-0275-5. PMID 16572283.
- ↑ Vencovský J, Machácek S, Sedová L, Kafková J, Gatterová J, Pesáková V, Růzicková S (May 2003). "Autoantibodies can be prognostic markers of an erosive disease in early rheumatoid arthritis". Ann. Rheum. Dis. 62 (5): 427–30. PMC 1754544. PMID 12695154.