Prevalence of extraarticular manifestations in rheumatoid arthritis and their relationship with serological status and disease severity

Authors

DOI:

https://doi.org/10.18203/2349-3933.ijam20223395

Keywords:

Extraarticular manifestations, Rheumatoid arthritis, Rheumatoid factor, Seronegativity, Seropositivity

Abstract

Background: Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that attacks the synovial joints. It affects body systems, such as the skin, cardiovascular, respiratory systems, and other systems, which manifest as extraarticular manifestations. This study aimed to correlate RA with extraarticular manifestations and its relationship with serological status.

Methods: One hundred fifty patients (30 male and 120 female) RA patients with a mean age of 49.9±11.9 attending the Rheumatology outpatient department and biological therapy center in Basrah Teaching Hospital were enrolled in the study and fulfilled the 2010 RA classification criteria of the American college of rheumatology/European league against rheumatism for RA. All the subjects underwent a thorough history, clinical examination, and laboratory investigations. Body mass index (BMI), the severity of pain using a visual analog scale (VAS) and disease activity using 28 joints (DAS28), and erythrocyte sedimentation rate were calculated for all patients. The relevant data were analyzed with appropriate statistical methods after 12 months.

Results: The mean age, age at onset, disease duration, and BMI were 49.9±11.9, 41±2.1, 14.6±5.8, and 26.8±4.8 respectively. The disease onset was acute in 45 (30%) and insidious in 105 (70%) patients. Anemia, rheumatoid nodule, sicca syndrome, Felty syndrome, Sjogren syndrome, and joint erosions were more frequent in seropositive than seronegative patients. There is no difference in joint deformities between seropositive and seronegative patients. DAS28, VAS, ESR, and CRP were higher in patients with extraarticular manifestations.

Conclusions: Extraarticular manifestations are significantly associated with seropositive disease and correlate to disease severity.

Author Biography

Abdulsatar J. Mathkhor, Department of Rheumatology, Basrah Teaching Hospital, Basrah, Iraq

Department of Rheumatology

References

Turesson C, Matteson EL. Management of extra-articular disease manifestations in rheumatoid arthritis. Curr Opin Rheumatol. 2004;16(3):206-11.

Gabriel SE, Crowson CS, Kremers HM, Doran MF, Turesson C, O'Fallon WM, et al. Survival in rheumatoid arthritis: a population-based analysis of trends over 40 years. Arthr Rheumat. 2003;48(1):54-8.

Cimmino MA, Salvarani C, Macchioni P, Montecucco C, Fossaluzza V, Mascia MT, et al. Extra-articular manifestations in 587 Italian patients with rheumatoid arthritis. Rheumatol Int. 2000;19(6): 213-7.

Horton MR. Rheumatoid arthritis associated interstitial lung disease. Critic Rev Comput Tomogy. 2004;45(5-6):429-40.

Kishore S, Maher L, Majithia V. Rheumatoid vasculitis: a diminishing yet devastating menace. Curr Rhumatol Rep. 2017;19(7):1-7.

Turesson C, Jacobsson L, Bergström U, Truedsson L, Sturfelt G. Predictors of extra-articular manifestations in rheumatoid arthritis. Scand J. 2000;29(6):358-64.

Young A, Koduri G. Extra-articular manifestations and complications of rheumatoid arthritis. Best Pract Res Clin Rhumatol. 2007;21(5):907-27.

Bongartz T, Cantaert T, Atkins SR, Harle P, Myers JL, Turesson C, et al. Citrullination in extra-articular manifestations of rheumatoid arthritis. Rheumatology. 2007;46(1):70-5.

Roudier J. HLA-DRB1 genes and extraarticular rheumatoid arthritis. Arthritis Res Ther. 2006;8(1):1-2.

Alarcón GS. The influence of sex on the frequency of erosive disease and extraarticular manifestations in rheumatoid arthritis: comment. Arth Rheumat: J College of Rheumatol. 1999;42(3):587-8.

Gossec L, Baro-Riba J, Bozonnat MC, Daurès JP, Sany J, Eliaou JF, Combe B. Influence of sex on disease severity in patients with rheumatoid arthritis. J Rheumatol. 2005;32(8):1448-51.

Kinoshita M, S Aotsuka, and R Yokohari. Cross-reactive rheumatoid factors in rheumatoid arthritis with extra-articular disease. Clin Exp Immmunol. 1990;79(1):72-7.

Calguneri M, Ureten K, Ozturk MA, Onat AM, Ertenli I, Kiraz S, Akdogan A. Extra-articular manifestations of rheumatoid arthritis: results of a university hospital of 526 patients in Turkey. Clin Experimentrheumato1. 2006;24(3):305.

Picerno V, Ferro F, Adinolfi A, Valentini E, Tani C, Alunno A. One year in review: the pathogenesis of rheumatoid arthritis. Clin Exp Rheumatol. 2015; 33(4):551-8.

Marcucci E, Bartoloni E, Alunno A, Leone MC, Cafaro G, Luccioli F, et al. Extra-articular rheumatoid arthritis. Reumatismo. 2018 Dec 20;70(4):212-24.

Turesson C. Extra-articular rheumatoid arthritis. Curr Opin Rheumatol. 2013;25(3):360-6.

Turesson C, Jacobsson L, Bergström U. Extra-articular rheumatoid arthritis: prevalence and mortality. Rheumatology. 1999;38(7):668-74.

Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham III CO, et al. 2010 rheumatoid arthritis classification criteria: an American College Of Rheumatology/European league against Rheumatism collaborative initiative. Arthritis Rrheumatism. 2010; 62(9):2569-81.

Salaffi F, Ciapetti A, Carotti M, Gasparini S, Gutierrez M. Disease activity in psoriatic arthritis: Comparison of the discriminative capacity and construct validity of six composite indices in a real world. Biomed Res Int. 2014.

Kumar B, Das MP, Misra AK. A cross-sectional study of association of serostatus and extra-articular manifestations in patients with rheumatoid arthritis in a teaching hospital. J Family Med Prim Care. 2020; 9(6):2789.

Turesson C, McClelland RL, Christianson T, Matteson E. Clustering of extraarticular manifestations in patients with rheumatoid arthritis. J Rheumatol. 2008;35(1):179-80.

Al-Dalaan A, Al Ballaa S, Bahabri S, Biyari T, Al Sukait M, Mousa M. The prevalence of rheumatoid arthritis in the Qassim region of Saudi Arabia. Ann Saudi Med. 1998;18(5):396-7.

Hochberg MC, Johnston SS, John AK. The incidence and prevalence of extra-articular and systemic manifestations in a cohort of newly-diagnosed patients with rheumatoid arthritis between 1999 and 2006. Curr Med Res Opin. 2008;24(2):469-80.

Carmona L, Gonzalez-Alvaro I, Balsa A, Belmonte MA, Tena X, Sanmarti R, et al. Rheumatoid arthritis in Spain: occurrence of extra-articular manifestations and estimates of disease severity. Ann Rheumat Dis. 2003;62(9):897-900.

Turesson C, O'Fallon WM, Crowson CS, Gabriel SE, Matteson EL. Occurrence of extraarticular disease manifestations is associated with excess mortality in a community based cohort of patients with rheumatoid arthritis. J Rheumatol. 2002;29(1):62-7.

Corcoran JP, Ahmad M, Mukherjee R, Redmond KC. Pleuro-pulmonary complications of rheumatoid arthritis. Resp Care. 2014;59(4):e55-9.

Intriago M, Maldonado G, Cárdenas J, Ríos C. Clinical characteristics in patients with rheumatoid arthritis: differences between genders. Sci World J. 2019.

Shankar S, Grover R, Handa R. Role of anti cyclic citrullinated peptide antibodies in erosive disease in patients with rheumatoid arthritis. Indian J Med Res. 2006;124(6):689-96.

El Sawi HA, Abd EL-Ghaffar N, Mansour MA. Relationship between anti-cyclic citrullinated peptide antibodies and disease activity and extra-articular manifestations of rheumatoid arthritis in Egyptian patients. Al-Azhar Assiut Med J. 2011;9(1):21-35.

Turesson C, Jacobsson LT, Sturfelt G, Matteson EL, Mathsson L, Rönnelid J. Rheumatoid factor and antibodies to cyclic citrullinated peptides are associated with severe extra-articular manifestations in rheumatoid arthritis. Ann Rheum Dis. 2007;66(1): 59-64.

Sahatçiu-Meka V, Rexhepi S, Manxhuka-Kërliu S, Rexhepi M. Extra-articular manifestations of seronegative and seropositive rheumatoid arthritis. Bosnian J Basic Med Sci. 2010;10(1):26.

Itty S, Pulido JS, Bakri SJ, Baratz KH, Matteson EL, Hodge DO. Anti-cyclic citrullinated peptide, rheumatoid factor, and ocular symptoms typical of rheumatoid arthritis. Transact Am Ophthalmol Soc. 2008;106:75.

Sahatçiu-Meka V, Rexhepi S, Manxhuka-Kërliu S, Rexhepi M. Extraaricular manifestation of seronegative and seropositive reumathoid arthritis Bosn. J Basic Med Sci. 2010;10(1):27-31.

Hamamoto Y, Ito H, Furu M, Hashimoto M, Fujii T, Ishikawa M, et al. Serological and progression differences of joint destruction in the wrist and the feet in rheumatoid arthritis-a cross-sectional cohort study. PLoS One. 2015;10(8):e0136611.

Syversen SW, Gaarder PI, Goll GL, Ødegård S, Haavardsholm EA, Mowinckel P, et al. High anti-cyclic citrullinated peptide levels and an algorithm of four variables predict radiographic progression in patients with rheumatoid arthritis: results from a 10-year longitudinal study. Ann Rheumat Dis. 2007; 67(2):212-7.

Tobón G, Saraux A, Lukas C, Gandjbakhch F, Gottenberg JE, Mariette X, et al. First-year radiographic progression as a predictor of further progression in early arthritis: results of a large national French cohort. Arth Care Res. 2013; 65(12):1907-15.

Yamanaka H, Matsuda Y, Tanaka M, Sendo W, Nakajima H, Taniguchi A, et al. Serum matrix metalloproteinase 3 as a predictor of the degree of joint destruction during the six months after measurement, in patients with early rheumatoid arthritis. Arthritis & Rheumatism: Official J Am Coll Rheumatol. 2000;43(4):852-8.

Forslind K, Kälvesten J, Hafström I, Svensson B. Does digital X-ray radiogrammetry have a role in identifying patients at increased risk for joint destruction in early rheumatoid arthritis?. Arth Res Ther. 2012;14(5):1-9.

Terao C, Yano K, Ikari K, Furu M, Yamakawa N, Yoshida S, et al. Brief report: main contribution of DRB1 04: 05 among the shared epitope alleles and involvement of DRB1 amino acid position 57 in association with joint destruction in anti-citrullinated protein antibody-positive rheumatoid arthritis. Arth Rheumatol. 2015;67(7):1744-50.

Vittecoq O, Pouplin S, Krzanowska K, Jouen‐Beades F, Menard JF, Gayet A, et al. Rheumatoid factor is the strongest predictor of radiological progression of rheumatoid arthritis in a three-year prospective study in community-recruited patients. Rheumatology. 2003;42(8):939-46.

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2022-12-27

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