The natural history of rheumatoid arthritis: a fifteen year follow-up study. The prognostic significance of features noted in the first year.

One hundred patients with definite or classical rheumatoid arthritis have been followed since the early months of their disease; after 15 years the 65 surviving patients were reviewed. Their functional capacity had fallen by comparison with reviews made 3 and 11 years after onset, but half were still unimpaired or only moderately so (grade 1 and 2). The number of affected joints had risen to an average of 8 joints in men and 13 in women, but the ESR and the titre of the Rose test were lower than in the first year. Haemoglobin levels had risen in men, but fallen in women. The first-year titre of the Rose test proved to be of great prognostic significance, regarding ARA grading and number of affected joints after 15 years, but it did not correlate with the functional capacity. However, the functional capacity at 3 years correlated significantly with its value at 11 and 15 years. Patients with rheumatoid nodules were significantly worse than the remainder in many respects. A positive Schirmer test, showing diminished tear secretion, did not relate to any of the clinical parameters. The medical and surgical treatment is briefly reviewed.