Frequency and Predictors of Extra-articular Manifestations in Patients with Rheumatoid Arthritis

Abstract

Aim: To evaluate the frequency and the predictors of extra-articular manifestations (EAMs) in rheumatoid arthritis (RA) patients. Patients and Methods: This study included 100 adult rheumatoid arthritis patients. A full medical history and a thorough clinical and rheumatological examinations, along with laboratory and radiological investigations were done. RA disease activity using the modified disease activity score (DAS28), validated Arabic version of the health assessment questionnaire (HAQ-A) and the simplified erosion narrowing score (SENS) were calculated. Results: EAMs were detected in 73 patients (73%) of the RA patients; the most common EAMs were subcutaneous rheumatoid nodules (45%), followed by anemia (43%), ocular affection (23%), pulmonary affection (interstitial lung disease ILD) (15%), neuropathy (10%) while renal and cardiac involvements were (2%) and (1%) respectively. There were statistically significant higher levels of age, disease duration, disease activity (DAS28), severe functional disability (HAQ-A), joint damage (SENS), rheumatoid factor (RF) positivity and CRP levels among RA patients with EAMs than those without EAMs. The multivariate regression analysis of the possible predictors of RA EAMs showed that disease duration (OR 1.8, 95% CI. 1.2-2.9, p=0.006) and disease activity DAS28 (OR 1.6, 95% CI 1.0-2.4, p=0.045) independently affect the occurrence of EAMs in RA patients. Conclusion: Extra-articular manifestations are common among rheumatoid arthritis patients. Disease duration and disease activity were independent predictors of extra-articular manifestations occurrence in rheumatoid arthritis.