Swedish clinicians have identified three risk factors for severe extra-articular manifestations in patients with a recent diagnosis of rheumatoid arthritis (RA).
The team, led by Britt-Marie Nyhäll-Wåhlin, from Falun Hospital, found that high levels of disease and disability in the first 2 years after diagnosis were significant prognostic factors for severe extra-articular RA, as were smoking and seropositivity for rheumatoid factor (RF).
“These results support the importance of decreasing disease activity extensively in patients with early RA,” the researchers write in the journal Rheumatology.
“Since the clinical course of RA is highly variable, further studies should aim at defining prognostic markers that could identify patients at risk for poor outcome and guide treatment strategies.”
The team compared medical records for 40 patients with severe extra-articular manifestations, such as interstitial lung disease, pleuritis, and neuropathy, with charts for 120 patients without such symptoms, who were matched for age, gender, and duration of symptoms.
Baseline analysis showed that patients with severe extra-articular RA were more often current smokers than those without (45% vs 28%), and were more likely to be seropositive for RF (93% vs 59%).
Moreover, patients with extra-articular manifestations had significantly higher baseline scores on the Disease activity score (DAS28) and Health Assessment Questionnaire for functional disability (HAQ) than those without, as well as higher C-reactive protein (CRP) levels.
Indeed, area under the curve analysis for DAS28, HAQ, and CRP scores in the first 2 years after diagnosis gave odds ratios for subsequent development of extra-articular RA of 7.79, 2.30, and 3.05, respectively
Although disease-modifying anti-rheumatic drug use was similar in patients with and without extra-articular RA, patients with manifestations had more frequent use of glucocorticoids than controls and higher mean cumulative doses.
“Since they had higher cumulative disease activity, our study supports the concept that poorly controlled early RA is associated with adverse long-term outcomes, and provides yet another rationale for aggressive treatment, including biologics, in patients with persistent disease activity,” Nyhäll-Wåhlin et al conclude.
“Furthermore, our data suggest a role for long-term effects of inflammation in the development of extra-articular organ involvement in RA.”