- Predicting the Progression of RA

[Guest guest]

,

There are no hard and fast rules regarding the length of time from diagnosis

of RA to permanent damage and/or destruction of joints; in fact, some

patients can present with erosions and/or joint space narrowing, and others

can live their entire lives without suffering loss of function or

derangement of a joint. There is much variability, but we do know that

serious damage can occur in the early stages of the disease and, without

treatment, can steadily continue. Unfortunately, even with treatment, joint

damage is possible.

Researchers have been seeking to elucidate the characteristics of patients

who suffer more aggressive disease and what the general timeframes may be.

" One important finding is that radiographic damage occurs early in the

course of rheumatoid arthritis. In fact, van der Heidje and coworkers

reported that 70% of patients in their study developed radiographic damage

within 3 years of onset. The rate of radiographic progression was higher in

the first than in the second or third year of disease activity. This

suggests that the opportunity to intervene and possibly modify the course of

disease before structural damage occurs may appear earlier rather than

later. "

Source: " Rheumatoid Arthritis: Treat Now, Not Later! "

http://www.acponline.org/journals/annals/15apr96/arthedit.htm

Treatment used to begin (and still does under the care of physicians who

aren't reading, learning, and thinking!) very conservatively, and DMARDs

were tried only after common analgesics, NSAIDs, and steroids failed (the

infamous " pyramid " approach; here's a reference to an editorial essay whose

title tickles me: McCarty DJ. " Suppress rheumatoid inflammation and leave

the pyramid to the Egyptians " [Editorial]. J Rheumatol. 1990;17:1115-8). Now

we realize that the " let's wait and see if we really need the big guns "

strategy is not the best approach for many RA patients.

Early, aggressive treatment is warranted in cases that have indications for

a more severe prognosis. As alluded to in the quoted paragraph above, it has

also been suggested that early in the course of rheumatoid arthritis there

is a " window of opportunity " during which treatment has a better chance of

positively and significantly altering the progression of the disease.

Here are some links that will provide you some information related to your

question:

http://www.annals.org/issues/v131n10/full/199911160-00009.html

http://www.findarticles.com/m3225/6_61/61432896/p1/article.jhtml

http://www.asca.com/updates/1-2/11.htm

http://www.hopkins-arthritis.som.jhmi.edu/edu/acr2000/ra-earlyra.html

This is why I am concerned that your rheumatologist has not ordered any

x-rays yet. Normally, in a newly diagnosed RA patient, a physician would

want to see if there is any damage already and have a baseline with which to

compare in the future. That information should guide the treatment plan and

be used to assess its effectiveness. Too, since we now realize that early

diagnosis and immediate, effective treatment are extremely important in RA,

there has been much debate recently about whether MRIs should be used

instead of x-rays, since, although costlier, they show much more

information.

So, , try not to be frightened, but do be sure that your diagnosis

is correct and that your treatment plan is the best it can be under your

particular set of circumstances.

----- Original Message -----

From: <cwade@...>

< >

Sent: Friday, May 25, 2001 5:07 PM

Subject: [ ] Question?

> How long, if untreated, before damage starts to appear. Lets say

> best case/worst case. How long do I have? To me it seems like I get

> worse and worse every day. I'm scared. But I can't afford to get

> all worked up about it. When I stressed or over worked it seems to

> get worse. But it is never better. I can't remember the last time I

> had a no flare day.

>

>