Disease outcome and functional capacity in rheumatoid arthritis
- PJW Venables, MA, MB BChir, MD, FRCP
PJW Venables, MA, MB BChir, MD, FRCP
- Professor of Viral Immunorheumatology
- Kennedy Institute, Oxford University
- Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
- Section Editor — Rheumatoid Arthritis
- Emeritus Professor of Rheumatology, Imperial College London
- Visiting Professor, Oxford University
The course of rheumatoid arthritis (RA) is variable . Approximately 15 to 20 percent of patients have intermittent disease with periods of exacerbation and a relatively good prognosis. However, most patients have progressive disease, with either a slow or a rapid course. The outcome of RA is dependent upon the degree of joint damage, the physical functional status of the patient, psychological health, and the presence of comorbid illness such as cardiovascular disease, infection, and B cell lymphomas. A reduced life expectancy is seen in some patients with severe RA, due to illnesses that may be the result of RA itself or the drugs used in its treatment (table 1).
Functional capacity, comorbidities, and mortality in RA are reviewed here. Cardiovascular and renal diseases associated with RA are discussed elsewhere. (See "Coronary artery disease in rheumatoid arthritis: Implications for prevention and management" and "Coronary artery disease in rheumatoid arthritis: Pathogenesis, risk factors, clinical manifestations, and diagnostic implications" and "Heart failure and left ventricular dysfunction in rheumatoid arthritis" and "Causes and diagnosis of membranous nephropathy", section on 'Drugs, particularly penicillamine and gold' and "Clinical manifestations and diagnosis of the mixed cryoglobulinemia syndrome (essential mixed cryoglobulinemia)" and "Causes and diagnosis of secondary (AA) amyloidosis and relation to rheumatic diseases" and "NSAIDs: Acute kidney injury (acute renal failure)".)
Loss of functional capacity in rheumatoid arthritis (RA) is a result of the summation of loss of function in individual joints. Individual joint function depends upon numerous factors:
●Severity of disease activity
●Structural integrity of a joint
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