Extra Articular Manifestations in Egyptian Rheumatoid Arthritis Patients

Abstract

Background: Rheumatoid arthritis is a systemic inflammatory disease that can involve other tissues and organs as well as synovial joints. It is characterized by destructive polyarthritis and extra-articular organ involvement, including skin, eye, heart, lung, renal, central and peripheral nervous system and gastrointestinal tract. The extra-articular manifestations of RA can occur at any age. Objectives of this study are to evaluate extra articular manifestations in Egyptian rheumatoid arthritis patients, its relation to the disease activity score (DAS28) and Anti-Cyclic Citrullinated Peptide (ACPA). Methods: This study was conducted on 50 patients they were diagnosed as RA by fulfilling the American College of Rheumatology (ACR) criteria of RA. Their age (mean±SD) is 45.78±13.26 years. Forty four (88%) of them were females, 6 (12%) were males. They were subjected to full medical history and examination, laboratory investigations were done, calculation of DAS28 score, measurement of plasma Anti-Cyclic Citrullinated Peptide (ACPA). RA patients were classified according to DAS 28 into three groups. Results: RA group 1 (mild disease activity) includes 12 (24%) patients with mean±SD of DAS 28 was 2.5±0.55, group II (moderate disease activity) includes 28 (56%) patients with mean±SD of DAS 28 was 3.9±0.55 and group III (severe disease activity) includes 10 (20%) patients with mean±SD of DAS 28 was 5.35±0.238. There was highly significant increase in mean±SD of ACPA titer in group III (sever activity), 90.31±40.78 IU/ml than that of group II 56.48±27.62 IU/ml, (p=0.000) and group1; 36.74±18.95 IU /ml also mean ACPA in group II increased significantly than that of group I, (P=0.000). Fifty (100%) RA patients had extra articular manifestations (ExRA); 37 (74%) had respiratory system disorders, 35 (70%) had hematological manifestations. CVS manifestations were found in 23 (46%). Eye manifestations present in 23 (46%) RA patients. Twelve (24%) RA patients had skin manifestations. GIT manifestations occur in 11 (22%) patients, 5 (10%) RA patients had renal manifestations. Four (8%) RA patients had neurological manifestations. The most common ExRA respiratory disorders was found in 8/12 (66.6%) patients in group I while it affect 22/28 (78.5%) patients in group II and 7/10 (70%) patients in group III (P = 0.000) with highly significant changes. Conclusion: This study showed that the ExRA are a common feature in Egyptian RA patients and they are related to the disease activity. [Egypt J Rheumatology & Clinical Immunology, 2014; 2(1): 71-79]