A cross-sectional study of association of serostatus and extra-articular manifestations in patients with rheumatoid arthritis in a teaching hospital

Abstract

Background: Rheumatoid arthritis (RA) is an autoimmune disease, which mistakenly attacks the joints and induces the inflammatory changes that thicken the joints (the synovium) resulting in swelling and pain in and around the joints. It causes pain, joint deformity, and also affects the quality of life. The joint is affected symmetrically. It also can affect body systems, such as the cardiovascular, respiratory systems, or other systems, which manifest as extra-articular manifestations. Extra-articular manifestations of RA are documented less in India hence this study was undertaken to correlate RA with extra-articular manifestations as well as its relationship with serostatus in patients with extra-articular manifestations. Materials and Methods: Sixty patients (age between 18–60 years) attending Medicine/Rheumatology outpatient department were included in the study (12 months) who fulfilled the 2010 RA classification criteria laid down by American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) for RA. All the subjects underwent a thorough history, clinical examination, and laboratory investigations. The relevant data were analyzed with appropriate statistical methods after 12 months’ duration. Results: Nearly 68.33% of the subjects were found to have extra-articular manifestations mostly in the age group of 31–40 years with prevalence higher in the female. In the seropositive patients, early morning stiffness (EMS) constitutes 63.82% of the total extra-articular manifestations in the patients followed by anemia (38.29%) and peripheral neuropathy (34.04%). On the other hand, in the seronegative cases, EMS (61.53%) followed by anemia (23.07), peripheral neuropathy (15.38%), and keratoconjunctivitis sicca (15.38%). Extra-articular manifestations in seropositive patients have a statistically significant relationship with the increase in the duration of the disease. Conclusion: Extra-articular manifestations need to be looked carefully as it is associated with more severe disease. Seropositivity and extra-articular manifestations both usually indicate that the RA is more severe and may affect the quality of life.

Frequency of extra-articular manifestations in cohort of Pakistani patients presented with RA at Independent University Hospital Faisalabad.

“…Our finding was like many other studies that showed increasing duration has strong association with extra articular manifestations. 14,28,29 Very rarely noted findings in our study was felty syndrome <1%, osteoporosis. No single case was noted for amyloidosis.…”

“…Mean age of patients in my study was 39 years and most of patients belong to age group of 31-45 years, which was also comparable to other studies. 13,14 Our study has strong correlation of seropositivity with extra articular manifestations, having statistically significant importance (p value: <0.01). Shankar S et al 15 and others found that up to 80% of patients were seropositive rheumatoid arthritis in their studies during assessment of extra articular manifestations.…”

“…9.9% of patients in our study were found to have rheumatoid nodules at different level of presentations. Kumar B et al 14 showed 16.6% of patients have rheumatoid nodules in their patients. Many authors found that the prevalence of rheumatoid nodules was 20-30% in white peoples while in some countries it was 2-5% especially outside Europe.…”

“…A recent study conducted in India showed almost 63.3% of patients have extra articular manifestations. 14 This high incidence of extra articular manifestations may be due to study design and selection criteria. They even included clinical manifestations of disease as extra articular forms like early morning stiffness and anemia of all forms.…”

Clinical Manifestations, Pathogenesis, Diagnosis and Treatment of Peripheral Neuropathies in Connective Tissue Diseases: More Diverse and Frequent in Different Subtypes than Expected

“…Interestingly, the incidence of PN varied according to the different subtypes of RA. Kumar et al [50] reported that the prevalence of PN in seropositive RA patients and seronegative RA patients was 34.4% vs. 15.4, respectively. Further studies are required to clarify the clinical and pathological relationships between seropositive and seronegative RA patients.…”