50 years of antirheumatic therapy: the prognosis of rheumatoid arthritis.

The longterm prognosis of rheumatoid arthritis (RA) is bad. All markers of outcome--mortality, functional ability, cumulative pain, economic costs, and adverse reactions to therapy--are unfavorably altered in this illness. But considerable evidence exists that pharmacologic and nonpharmacologic interventions can alter the course of RA by decreasing work and functional disability, and improving the quality of life of those with RA. Therapy alters the slope of RA decrement, permanently or intermittently. Such changes, however, are difficult to measure in short-term cross-sectional studies, and the effect of treatment may be underestimated.