There are secular trends in improvement in disease activity and X-ray damage at baseline and cross-sectionally in prevalent cases of rheumatoid arthritis (RA) in recent years. These changes should translate into improved physical function and mortality, but evidence for this is lacking, perhaps because the mean age at RA diagnosis and of prevalent cases is increasing, mainly as a consequence of demographic changes. This trend is accompanied by an increasing prevalence of co-morbidities, in particular cardiovascular and respiratory disease. The higher prevalence of smoking, diabetes and physical inactivity in RA cases contributes to the burden of co-morbidity. Predictors of poorer treatment response and thus a worse prognosis include female gender, being a smoker, autoantibody positivity, high baseline disease activity and co-morbidities such as depression. There is a need for better understanding of predictors of treatment response to guide the right choice of therapy and thus improve outcome further.
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