A number of clinical and laboratory findings may identify a patient with rheumatoid arthritis who has a worse prognosis. These can help to identify a patient who may benefit from more aggressive management.
Criteria for worse outcome: rapid disease progression, early disability, need for joint replacements, other morbidities
Markers of poor prognosis:
(1) worse physical functioning and disability (Health Assessment Questionnaire Disability Index, HAQ-DI)
(2) extra-articular disease (vasculitis, RA lung disease, Sjogren's syndrome, etc)
(3) elevated titers of RA and/or anticyclic citrulinated peptide antibodies
(4) radiographic evidence of bony erosions
Additional factors that may be associated with a worse prognosis:
(1) older age
(2) female sex
(3) smoking
(4) high tender and swollen joint counts
(5) elevated ESR and/or C-reactive protein
(6) HLA-DRB1 shared epitope
