The natural history of rheumatoid arthritis over 20 years. Clinical symptoms, radiological signs, treatment, mortality and prognostic significance of early features.

A 20 year follow up is reported on 100 patients with definite or classical rheumatoid arthritis when they were all initially seen within one year of the onset of arthritis. Forty-six patients have died and in 17 death was due to or related to RA. Mortality was greater in men than in women and in patients who had classical rather than definite RA at one year. Thirty of the surviving 54 patients have either no or only moderate restriction of physical activity. Those who had definite RA at one year are now better as regards functional capacity and joint score than those who had classical RA. In general the titre of the Rose test has tended to fall and those who have become seronegative have done better than those remaining seropositive.