In rheumatoid arthritis (RA), not only outcome measurements taken at a single point in time, but also the severity during the entire disease period is important. In this investigation we measured severity in terms of the course of disease activity. It is the activity of the disease which leads to most suffering in the patient, and which we try to alleviate.
Patterns of disease activity were investigated in 132 female patients who were followed yearly from an early phase of the disease for a mean duration of 6 years.
Sixty-seven patients (50.8%) continuously had < or = 4 swollen joints (low activity), 23 patients (17.4%) continuously had > or = 4 swollen joints (high activity), in 10 patients (7.6%) disease activity decreased from high to low, in 8 patients (6.1%) disease activity increased from low to high, and 24 patients (18.2%) had fluctuating levels of disease activity. The outcome of the disease as measured by the functional ability, the radiological abnormalities, and number of prescribed 2nd line drugs, was best in patients with continuously low levels of disease activity, and worst in patients with continuously high or increasing levels of disease activity.
For about half of the female patients presenting to a rheumatology outpatient clinic, the severity of RA after 6 years of disease duration is characterized by continuous but low disease activity, and sufficient preservation of functional ability. For the other half of the patients RA is a progressive and disabling disease.