We reviewed the records of 44 patients, retrospectively selected because they had had persistently active rheumatoid arthritis for more than 5 years (mean f SD followup 9.8 f 2.6 years) and because they met the American Rheumatism Association criteria for classic disease, to determine the change in extent of the anatomic distribution of joint involvement over time. The positive predictive value of a lack of inflammation in a joint during the first year for the lack of involvement over the ensuing 4 years was 87%. Thirty-eight of the 43 joints that required replacement were inflamed in the first year of disease.
The prevailing perception of rheumatoid arthritis (RA) is that of an extremely variable disease (I). However, there are typical courses. An intermittent disease course is present in a few cases; a rapidly progressive course, which reaches a plateau of vigorous activity, accounts for another small group who proceed to a rapid onset of disability; the remainder of patients with RA follow a slowly progressive course, with periodic exacerbations that occur weeks to years apart (2-4). Predictions of the course of RA have relied on intermittent symptoms at presentation (3, older age at onset (6), or rapidity of onset (7) to suggest From Brigham and Women's Hospital and the Robert B.