Health Questions and Answers

Question: What evidence confirms the fact that reduced function rapidly follows the mechanical derangement of the joint?

Answer:

One study revealed that patients treated conservatively (putting off disease-modifying anti-rheumatic drugs [DMARDs] until trials of NSAIDs, low-dose steroids, physical therapy, splinting, and other modalities had failed) suffered a moderate loss of function with 2 years, a severe loss of function with 6 years, and a very severe loss by 10 years. If ability to maintain work status is used as a measure of function, statistics are even grimmer. Fifty percent of patients were disabled after 10 years and 60% after 15 years. An increased mortality rate (see previous question) has been recognized in patients treated in this way. Therefore, in an attempt to improve outcome, most rheumatologists now recommend earlier initiation of DMARDs and a more aggressive approach to management.

Reference: Harris ED, Budd RC, Firestein GS, et al (eds): Kelley’s Textbook of Rheumatology, 7th ed. Philadelphia, W.B. Saunders, 2005

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