What is the natural history of rheumatoid arthritis?

Analyses of the natural history of RA, recognizing that all patients receive therapies, indicate the following: 1. Classification criteria for RA identify individuals with (at least) three different types of pathogenetic processes and long-term outcomes; most patients seen in clinical settings have progressive disease. 2. Results of therapies documented to be efficacious in clinical trials are not applicable to the long-term course of RA, in part due to patient selection and the short-time frame of observation in clinical trials; most therapies for RA are not effective in most patients over long periods. 3. Over periods of 10 years or longer, most patients with RA experience radiographic progression and severe functional declines, and work disability is seen in 60% of patients after 10 years of disease. 4. Mortality rates are increased in patients with RA, although RA is generally not listed on death certificates. 5. Individual patients with RA who are at risk for early mortality may be identified through clinical markers, including many involved joints, comorbid cardiovascular disease, and poor functional status according to questionnaires and physical measures. 6. Patient behaviors and lifestyles identified through formal educational level as a marker appear of great importance in the prevalence, morbidity, and mortality of RA.