Published: 2017-01-05

Study of extra-articular manifestations and disease severity in patients with rheumatoid arthritis

Mahendrakumar Kalappan, Naufal Rizwan Taraganar Abubacker, Meenakshi Shetty, Kannan Rajendran, Warun Kumar Muthupillai Rathinam, Rajendran Karuthodiyil


Background: The prevalence of chronic diseases in modern industrialized nations is increasing and among these intractable conditions, rheumatoid arthritis (RA) stands out as a major cause of multiple medical problems. Rheumatoid arthritis is an inflammation of synovial tissue and is characterized by symmetric involvement of peripheral joints, with hands, feet and wrists being most commonly affected. RA also presents with systemic disturbances and extra-articular manifestations. The prevalence of RA is reported to be 0.5-1% in the population worldwide, affecting women more frequently than men. One study carried out in India reported a figure of 0.5%. Although considered a “joint disease”, rheumatoid arthritis is also associated with extra-articular manifestations. Prevalence of these manifestations is seen in about 40% of patients at any time during the course of the disease. The objective was to study extra-articular manifestations and disease severity in patients with rheumatoid arthritis.

Methods: A Cross sectional study carried out among RA patients in inpatients and outpatients of tertiary care hospital. Based on the criteria, patients were selected and clinical history and examination was done. Locomotor system was examined and the total number of swollen and tender joints were counted and patient’s perception of pain was analysed using visual analogue scale ( 0-100 mm) and disease severity was calculated using disease activity score 28 (DAS 28 score ).

Results: The results showed the mean age of rheumatoid arthritis to be 52.61 years, with the minimum age being 20 years and the maximum age being 81 years. Among 100 patients, 84% were females and 16% were males. Among 100 patients, 27% of patients had extra articular manifestations. The most common extra articular manifestation seen in the study was interstitial lung disease, a pulmonary manifestation, which was present in 11% of patients. There was a statistical significance between the association of extra-articular manifestation and disease severity.

Conclusions: Extra articular manifestations was seen in 27 % of patients , most common was interstitial lung disease, indicating more extensive investigative protocol warranted for diagnosing milder presentation of these serious manifestations.


Rheumatoid arthritis, Extra-articular manifestations of rheumatoid arthritis, Disease activity score 28

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