Disability in rheumatoid arthritis after monotherapy with DMARDs.

Rheumatoid arthritis (RA) is a progressive disease that leads to an increasing loss of functional ability. Its management should be multidisciplinary, focused primarily at the prevention of functional loss. The aim of the present study was to investigate the effectiveness of monotherapy with disease-modifying antirheumatic drugs (DMARDs) on the prevention of functional loss in RA patients. Of 188 patients with RA, 95 had received DMARD monotherapy (mainly gold salts, but also antimalarials and sulfasalazin) for at least 36 months; 93 patients had not received DMARDs because of their inability to attend the rheumatology clinic regularly because of accessibility difficulties. All 188 patients were examined at the start of the follow-up and at its completion, some 42 months later. The following parameters were determined at the two examinations: tenderness and pain in individual joints, functional independence, functional and working status, and the results of ancillary tests. At the end of the follow-up there was a decrease in functional independence and deterioriation in the functional and working status in both groups. Long-term monotherapy with DMARDs had not prevented functional loss or the ensuing disability in RA patients.