Extra-articular rheumatoid arthritis: prevalence and mortality

Abstract

In this series, serositis and cutaneous vasculitis were predominant extra-articular manifestations of RA; and mortality was greater in the ExRA than in the non-ExRA subgroup, perhaps due to a high frequency of associated heart disease.

Incidence of noncardiac vascular disease in rheumatoid arthritis and relationship to extraarticular disease manifestations

“…In this same cohort of patients, previous studies have shown the 30-year cumulative incidence of any extraarticular disease manifestation to be 46.0% and that of severe extraarticular disease to be 16.7% (13,14). The presence of severe extraarticular RA was a predictor of all noncardiac vascular disease subtypes, except for cerebrovascular disease alone.…”

“…Patients with RA, and particularly those with extraarticular RA, have an increased mortality due to cardiovascular disease (3,8,14,22). In patients with severe extraarticular RA, an increased mortality specifically due to heart disease has been suggested (14), and data from studies of larger patient samples indicate an increased mortality (27) and morbidity (28) from cardiovascular disease in this subset.…”

“…In patients with severe extraarticular RA, an increased mortality specifically due to heart disease has been suggested (14), and data from studies of larger patient samples indicate an increased mortality (27) and morbidity (28) from cardiovascular disease in this subset. This is the first study to indicate that severe extraarticular RA is associated with an increase in noncardiac vascular morbidities.…”

“…Noncardiac vascular disease-free survival curves were estimated using the Kaplan-Meier product limit method (25), with allowance for transferral of patients from the nonextraarticular RA group to the mild or severe extraarticular RA group. This was done for all patients with RA, for patients with severe extraarticular RA as previously defined (pericarditis, pleuritis, Felty's syndrome, major cutaneous or other organ vasculitis, neuropathy, scleritis, episcleritis, retinal vasculitis, and glomerulonephritis), and for patients with mild extraarticular RA as previously defined (amyloidosis, keratoconjunctivitis sicca, xerostomia, secondary Sjögren's syndrome, pulmonary fibrosis, bronchiolitis obliterans organizing pneumonia, cervical myelopathy, subcutaneous rheumatoid nodules, and rheumatoid nodules in other locations) (4,14). This allowed for comparison of vascular morbidity between patients with non-extraarticular RA and those patients with severe extraarticular RA and mild extraarticular RA, incorporating the time-varying nature of extraarticular RA manifestations.…”

“…The incidence rate of severe extraarticular manifestations in patients with RA has been estimated to be 1 per 100 person-years at risk (4). Patients with severe extraarticular RA have a significantly increased risk of premature mortality compared with those without extraarticular RA (13)(14)(15)(16)(17)(18). It has been suggested that this excess mortality is mainly due to cardiovascular disease (14).…”