Prognosis

RA patients treated aggressively and early have a good prognosis with most patients achieving good disease control.[69] If there is a delay in treatment initiation or the disease remains untreated, many patients are disabled within 10 years.[184] Untreated, RA is also associated with increased premature mortality, most commonly from coronary artery disease.

Flares of disease are common, even in patients well controlled with disease-modifying antirheumatic drugs (DMARDs). Temporary measures, such as oral corticosteroids, are usually adequate.

For patients in remission or with low disease activity who are taking biological agents, studies suggest that discontinuing the biological agents leads to an increased risk of losing remission or low disease activity and an increased risk of radiographic progression.[124][131]

The results of two systematic reviews suggest that:[123][124]

  • Disease activity-guided dose tapering of TNF-alpha inhibitors is comparable to continuation of treatment with respect to the proportion of patients with persistent remission and may be comparable regarding disease activity

  • Discontinuation of TNF-alpha inhibitors is inferior to continuation of treatment with respect to disease activity, the proportion of participants with persistent remission, function, and minimal radiographic damage.

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