arthritis severity factors

What Determines How Severe Your Arthritis May Become?

A diagnosis of inflammatory arthritis can leave you wondering what you’re in for: Will you face along, bumpy road with your disease, or will it respond well to minimal treatment? Although there is no crystal ball, research into different forms of inflammatory arthritis is identifying factors that predict the likelihood of more or less severe disease.

Knowing these factors enables your doctor to target treatment, says David Pisetsky, MD, PhD, professor of medicine and immunology at Duke University Medical Center in Durham, North Carolina. “With evidence of a worse prognosis, most rheumatologists will monitor patients more closely, try to get disease control more rapidly and adjust medications to achieve a [disease] activity score as low as possible,” he says. Plus, steps to taper treatment in those who achieve remission “would be more cautious and gradual,” he adds.

Here are prognostic factors your doctor may consider.

Rheumatoid Arthritis


  • negative test for rheumatoid factor (RF) or anti-CCP antibodies
  • no joint damage visible on X-rays

More Severe:

  • positive test for RF or anti-CCP
  • joint erosions visible on X-ray
  • high disease activity as measured by erythrocyte sedimentation (sed) rate or C-reactive protein (CRP)

Psoriatic Arthritis


  • few joints involved
  • HLA-B44 genetic type

More Severe:

  • high sed rate
  • joint damage visible on X-rays
  • dactylitis (so-called “sausage” fingers or toes)
  • HLA-B27 genetic type

Ankylosing Spondylitis


  • female sex
  • absence of hip arthritis or dactylitis

More Severe:

  • male sex
  • early age at disease onset
  • early development of hip arthritis
  • high sed rate
  • dactylitis

What You Can Do

“Prognostic markers provide only a likelihood of a worse prognosis – not that you will have severe disease,” says Dr. Pisetsky. If you have unfavorable prognostic factors, he adds, let that encourage you to live a healthier life. You can take steps to influence the outcome, including seeing your doctor regularly, taking your medications as prescribed, exercising, maintaining a healthy weight and not smoking.

What About Osteoarthritis?

Prognostic factors can also be helpful in treating osteoarthritis (OA). They can alert doctors to monitor certain people more closely and stress the importance of lifestyle modifications, say authors of a review of 30 knee OA studies, published in Arthritis Research & Therapy. It found these factors associated with clinical knee OA progression: age (younger age at diagnosis was associated with greater symptom progression); ethnicity (non-whites fared worse than whites); high body mass index; additional illnesses; and swelling caused by fluid buildup in the joint.

Author: Mary Anne Dunkin

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