What is the long term prognosis for Rheumatoid Arthritis?
RA is clearly a disease that shortens survival and produces significant disability, especially before the use of modern therapeutic approaches that include early and more aggressive use of csDMARDs, bDMARDs, and tsDMARDs. Historically, RA was found to shorten the lifespan of patients by roughly 5 to 10 years. Many studies over the past decade, however, have demonstrated that RA mortality is improving and near that of non-RA populations in many countries (although rates are not quite equal yet). In addition, aggressive DMARD/biologic therapy appears to reduce disability (30%) and the need for joint replacement surgery (50%).
Some patients who are treated aggressively very early following the onset of synovitis (<3 months) may enter a state of prolonged disease remission (deep remission) and may be able to have therapy decreased or potentially withdrawn. Most studies that have investigated this area have focused on decreasing drug regimens rather than complete cessation of DMARD therapy (e.g., drug-free remission). Success with reducing medication regimens is more likely when attempted early in the course of RA (disease duration <2 years) and in seronegative patients.