Presentation of rheumatoid arthritis and its relation to prognosis.

A review of published reports in an attempt to relate the way rheumatoid arthritis presents to its manner of progression and prognosis has provided few positive answers. Certain, but not all, studies indicate that cases with an acute explosive onset do better than those of more insidious onset, but the latter have almost certainly lasted longer by the time they come under medical supervision. Cases of monarthritis and palindromic (remittent) arthritis do better than polyarthritic and persistent cases, but true diagnosis of the former is often uncertain. Undoubtedly persistent high-titre seropositivity and nodule formation are bad prognostic pointers. A plea is made for a more intensive study of the early case: if any therapeutic agent now or in the future can reverse the inflammatory process this is surely the time it is most likely to do so. This is the curable end of what is now an incurable disease.