Factors associated with poorer prognosis in rheumatoid arthritis * Insidious polyarticular onset * Male patients * Extra-articular manifestations * Functional disability at one year after start of disease * Substantially raised concentration of rheumatoid factors * Presence of HLA-DR4 * Radiographic evidence of erosions within three years of start of diseaseRheumatoid arthritis is the commonest disorder of connective tissues and is an important cause of disability, morbidity, and mortality.Life expectancy is reduced by four years in men and by 10 years in women, though this reduction is accounted for by a minority of patients with more severe disease.Nevertheless, patients with this condition may be offered life insurance only on the basis of loaded premiums.Rheumatoid arthritis occurs worldwide with variable incidence and severity.In Western countries, it affects up to 1-3% of the population, although many are not severely affected and may not seek medical advice at all.Overall, there is a 3:1 female preponderance, but this excess is greater in young people and the age related incidence is approximately equal in elderly people.Rheumatoid arthritis in women * Higher incidence of disease in women of child bearing age * Disease tends to go into remission during pregnancy and to flare after giving birth * Use of contraceptive pill or high gravidity adds some protection against later development of disease
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Akil et al. (1995) studied this question.