RESEARCH - High disease activity disability burden and smoking predict severe extra-articular manifestations in early RA

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Rheumatology Advance Access originally published online on February 12, 2009

Rheumatology 2009 48(4):416-420; doi:10.1093/rheumatology/kep004

High disease activity disability burden and smoking predict severe

extra-articular manifestations in early rheumatoid arthritis

Britt-Marie Nyhäll-Wåhlin1, Ingemar F. sson2, Jan-Åke Nilsson3,

Lennart T. H. sson3, Carl Turesson3 and the BARFOT study group*

1Department of Rheumatology, Falun Hospital, Falun, 2Department of

Rheumatology, Lund University Hospital, Lund and 3Department of

Rheumatology, Malmö University Hospital, Malmö, Sweden.

Abstract

Objectives. To identify patients with severe extra-articular RA (ExRA)

in an early RA cohort and to investigate potential risk factors.

Methods. From a cohort (n = 2900) in a structured programme for newly

diagnosed RA, 40 patients with severe ExRA after RA diagnosis were

identified. Disease activity score (DAS28), functional disability

(HAQ) and treatment with glucocorticosteroids (GCs) and DMARDs were

assessed regularly. Cases with ExRA were compared with RA controls

from the same cohort matched for age, sex and duration of symptoms at

inclusion.

Results. Patients who developed severe ExRA were more often current

smokers and had higher mean DAS28, HAQ and CRP at baseline. Among the

ExRA cases, 93% had a positive RF vs 59% of the controls. The area

under the curve (AUC) of DAS28 odds ratio (OR) 7.79/S.D.; 95% CI 3.04,

19.95, HAQ (OR 2.30/S.D.; 95% CI 1.37, 3.88) and CRP (OR 3.05/S.D.;

95% CI 1.77, 5.26) during the first 2 years of follow-up were strong

predictors of subsequent development of ExRA. The most frequently used

DMARDs were MTX and SSZ, with similar frequency and duration of

treatment among cases and controls. The cases were treated with GC

before onset of ExRA more frequently (73 vs 47%; P = 0.005) and with

higher mean cumulative dose (3667 vs 2037 mg, P = 0.015).

Conclusions. High levels of disease activity and disability during the

first 2 years after RA diagnosis, smoking and RF predict the

development of severe extra-articular RA.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/48/4/416?etoc

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