Longitudinal studies of rheumatoid arthritis (RA) have shown that joint damage often occurs early in the disease. Therefore, the early treatment of RA with "disease modifying" drugs is gaining acceptance. However, many patients presenting with inflammatory polyarthropathy will follow a benign course. Rheumatologists need to be able to target the use of potentially toxic drugs to those cases where the benefits clearly outweigh the risks. This approach requires reliable assessment of the prognosis at an early stage in the disease process. We have critically evaluated a large number of published studies which claim to provide clinically useful information regarding the prognosis of RA.
The majority of studies have methodological flaws which limit their value. A small number of published studies exist which provide useful data about estimating the prognosis of RA. Currently evaluated prognostic indicators are only moderately successful and there is an urgent need for methodologically sound research in this area.