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Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints for which, currently, there is not known cure. The primary goals of treatment for RA include controlling the symptoms, halting further progression of the disease, maintaining function, and preventing disability. Early and aggressive treatment with disease-modifying antirheumatic drugs (DMARDs) can lead to significant improvements in controlling the disease in many patients, however, complete remission of the disease is the exception rather than the rule.

The long-term prognosis (outlook) for patients with early stage rheumatoid arthritis (RA) is influenced by a variety of factors including:

• How soon the disease is diagnosed
• How many joints are affected by the disease at the time of diagnosis
• The functional status of the patient at the time of diagnosis
• How soon the disease is treated
• The extent to which the patient complies with the recommended treatment plan (drug therapy and supportive treatments)
• Whether or not there is a family history of RA
• Whether or not the patient tests positive for rheumatoid factor (RF) autoantibody
• The extent of the chronic inflammation as measured by blood tests (e.g., erythrocyte sedimentation rate; C-reactive protein)
• Whether or not there is early evidence of joint destruction by imaging studies

The long-term prognosis for patients with rheumatoid arthritis (RA) is also influenced by several other conditions that can develop during the course of the disease. Three conditions are of particular concern in patients with RA because they can have a negative impact on the overall prognosis:

• Infections - particularly lung infections
• Osteoporosis - brittle bones that can lead to vertebral fractures
• Atherosclerosis - hardening of the arteries that can lead to heart attack and stroke

If any of these conditions develop, early diagosis and treatment are crucial for preventing potentially serious complications that can lead to significant morbidity and mortality. Some measures can be taken by patients and their physicians to help reduce the risk of these complications:

• To reduce the risk of infections, make sure you get an annual flu vaccine and are also immunized with the pneumococcal polysaccharide vaccine (Pneumovax).

• If you have been diagnosed with osteoporosis, make sure you ask your doctor about a class of drugs called biphosphonates that have been shown to signficantly reduce the risk of bone fractures in people with osteoporosis.

• If you are a smoker, talk with your doctor about starting a smoking cessation program. In addition to the other known hazzards of smoking (lung cancer; emphysema; chronic bronchitis), smoking also increases your risk for developing hardening of the arteries and, thereby, increases your risk for heart attack and stroke.