This article discusses some of the prognostic factors used to guide arthritis specialists when they treat patients with rheumatoid arthritis.

Evidence suggests there is a narrow window of opportunity, perhaps as slim as 3 months, in which aggressive treatment with disease-modifying anti-rheumatic drugs can reduce x-ray damage and subsequent disability.

Once a diagnosis of rheumatoid arthritis has been made, it is important to recognize those patients who are at high risk for rapidly progressive disease.

These include patients who have multiple swollen joints, baseline x-ray damage, positivity for rheumatoid factor in the blood, and positive results for anti-CCP antibodies.

Patients with a poorer prognosis also may have functional impairment (inability to perform activities of daily living), elevations in erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).

Joint destruction can occur early and progresses if unchecked immediately.

Cigarette smoking is a known risk factor for developing rheumatoid arthritis. Its role in the progression of disease is still unknown.

Poor prognostic factors suggest that a patient may have more relentless and damaging disease. There may also be more resistance to therapy with less likelihood of early response to medication. Identifying this subset of patients is important because these patients must be treated even more aggressively.

Hopefully, with new research into biomarkers (biologic identifiers of disease type), it may be possible to custom tailor the treatment most likely to achieve remission in a given patient early. Genetic markers of disease may also be valuable in stratifying patients in the future.

It should be mentioned that slowing disease progression has taken a back seat to the goal of achieving remission. Remission is defined as being the absence of disease. However, there is a difference between remission and cure. Remission can be achieved with medications but medications may need to be continued. That is different from cure (or complete remission) where medicines can be discontinued and the patient remains free of disease. Future articles will discuss this concept in greater detail.

Early diagnosis and aggressive early management can spell the difference between achieving remission versus the development of severe deformity and crippling due to rheumatoid arthritis. Early evaluation by a rheumatologist is mandatory.