Rheumatoid Arthritis Prognosis: How Soon Will Symptoms Worsen?

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If you're newly diagnosed with rheumatoid arthritis (RA), you may be wondering how severe the disease will become and what you can expect moving forward. It's common to be curious and even anxious about your prognosis and what factors affect how quickly symptoms will get worse.

A lot of people in your position ask:

  • Will I face a mild or aggressive disease course?
  • Will pain become unbearable?
  • Is disability inevitable?
  • Will I be able to work and take care of my family?

There's no answer to these questions that applies to everyone with RA. Your healthcare provider may be able to provide you with some sense of this, but much will only become known over time. Proper treatment can help even those with an aggressive case to retain functionality for many years.

Determining Prognosis

Initially, your RA prognosis is based on how advanced the disease was when you were first diagnosed. Healthcare providers also consider your age at diagnosis or at disease-onset (when the disease began). Lastly, but probably most important, is how active the disease is at the time: Is your RA in a flare, a remission, or managed well with treatment?

  • A considerable amount of rheumatoid arthritis patients have a sudden onset of the disease, followed by many years with no symptoms. This is considered a prolonged remission.
  • Some rheumatoid arthritis patients have symptoms that come and go. Periods when there are few or no symptoms, which occur between flares, can last for months. This is referred to as intermittent symptoms of rheumatoid arthritis.
  • The majority of rheumatoid arthritis patients have the chronic, progressive type of rheumatoid arthritis that requires long-term medical management.

Identifying which pattern your symptoms fall into is an important part of knowing what to expect.

Prognosis is generally best for sudden onset RA that is followed by a prolonged remission, and less favorable for chronic and progressive disease activity.

Factors That Influence Disease Course

Several factors can influence the course of your disease. The more factors you have, the more likely it is that you'll have a progressive and destructive form of rheumatoid arthritis and a severe disease course.

Known influencing factors include:

  • Flares that are intense and last a long time (several months)
  • Age 18 to 47 at diagnosis
  • Length of active disease, with longer activity resulting in greater severity
  • Elevated markers of inflammation (CRP and ESR)
  • Significant joint damage evident on X-rays when diagnosed
  • Presence of rheumatoid nodules
  • Positive for rheumatoid factor or anti-CCP

Remember, though, that even people with severe, progressive disease can achieve remission with proper treatment.

Creating an Action Plan

If you and your healthcare provider have assessed the factors that influence your prognosis, the next thing to do is periodically reassess them. At certain intervals, you should have X-rays, laboratory tests, and an examination to see if your results have changed.

If you find that your disease is very active, you are in a flare that seems unstoppable, lab results are worse, or X-ray evidence of joint damage is more pronounced, your treatment options should be reconsidered.

You and your healthcare provider may need a new plan of attack to slow or halt disease progression. The 2021 American College of Rheumatology guidelines recommend the disease-modifying antirheumatic drug (DMARD) methotrexate as the first-line treatment for RA. If methotrexate alone isn't enough to manage your condition, other medications may be added or tried instead.

To determine whether you're becoming less functional, you can assess how well you perform your usual daily activities with the Health Assessment Questionnaire (HAQ). If you see a decline, you and your healthcare provider may want to re-evaluate your treatment regimen.

Life Expectancy

While rheumatoid arthritis itself isn't a fatal disease, it can have complications that shorten one's lifespan. This is a highly variable and individual aspect of the disease, and many people with RA live for an average or even above-average amount of time.

Additionally, life expectancy has improved greatly over the past several decades, thanks to better diagnostics and treatments, as well as improved awareness of complications (so they are caught and addressed sooner).

Factors that influence your life expectancy with RA include:

  • Symptom severity
  • Disease duration
  • Lung complications
  • Cancer risk
  • Heart disease
  • Drug complications
  • Sex (women tend to have more severe symptoms)
  • Diet
  • Smoking
  • Seropositive status

While you can't change all of those, you do have some control over several of these factors. Working with your healthcare provider to establish and modify habits may help you live a longer life.

A Word From Verywell

Without a doubt, RA will have an impact on your life. But remember that the outlook for those with the disease is improving as newer, better treatments become available and researchers learn more about the impact of lifestyle choices like smoking and eating a healthy diet.

If you're worried about becoming disabled, let your healthcare provider know. They may be able to reassure you or connect you with a therapist who can help you cope with your diagnosis and what it could mean for the future.

16 Sources
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By Carol Eustice
Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis.