Rheumatoid Arthritis - Epidemiology
Abstract #1914 Occurrence of Extra-Articular Disease Manifestations is Associated with Excess Mortality in a Population Based Cohort of Patients with Rheumatoid Arthritis C Turesson, W OFallon, C Crowson, S Gabriel, E Mattesom. Sweden and Minnesota.
Objective: In the clinical management of patients with rheumatoid arthritis, an important concern is to be vigilant for evidence of extra-articular disease because such features herald a more severe course. Recognizing that patients with rheumatoid arthritis are at increased risk of mortality, these investigators studied the relationship extraarticular manifestations to mortality.
Method: The investigators studied 424 cases with rheumatoid arthritis living in Olmsted County MN, who were diagnosed with RA between 1955-85. Extraarticular manifestation that were recorded included vasculitis, amyloidosis, sicca complex, pericarditis, pleuritis, pulmonary fibrosis, interstitial pneumonitis, scleritis and episcleritis, neuropathy, glomerulonephritis, nodulosis, and Feltys syndrome.
Results: In this group of patients, 182 patients (42.9%) had extraarticular manifestations. Of note, survival among the patients with extraarticular disease manifestations was markedly decreased compared to the general population and compared to the rheumatoid arthritis patients without extraarticular disease. Those patients with a few specific extraarticular manifestations, including vasculitis, pericarditis and Feltys syndrome, possessed a five-fold increased risk of mortality (RR = 5; 95% CI 3.3-7.6).
Editorial Comments:These findings, in a community based study, reinforce the consequences of extraarticular disease in rheumatoid arthritis and suggest that the more severe the disease, the greater the risk of mortality.
Abstract #294 In Early Rheumatoid Arthritis, Presence of Inflammation in Individual Hand Joints Predicts (progression of) Damage in that Joint M Boers, P Kostense, COBRA Trial. Amsterdam, The Netherlands.
Objective: An important issue in the evaluation of a patient presenting with new-onset rheumatoid arthritis is to recognize evidence of an aggressive clinical course. Identification of risk factors that predict joint damage would imply a greater need to initiate early aggressive therapy to prevent such damage.
Method: The COBRA Trial [which compared the efficacy of prednisolone, methotrexate and sulfasalazine against sulfasalazine alone] investigators examined this issue in their patients with new onset disease (median disease duration 4 months). They focused on the clinical and radiographic data at enrollment.
Results: Their analysis revealed that patients with positive rheumatoid factor, HLA-DR4, and high baseline disease activity experienced more severe progression. The presence of swelling, pain or radiographic evidence of damage, at baseline, each independently predicted progression of joint damage. These relationships applied to the erosion and joint space narrowing components of radiographic damage. Of particular note, the MCP joints were more than 4 times more likely to developing joint narrowing than PIP joints.
Editorial Comments: These findings reinforce the need to identify early, actively inflamed joints to minimize the potential for future joint damage, particularly at the MCP joint.
Abstract #603 Cigarette Smoking and Risk of Elderly Onset Rheumatoid Arthritis: Results from the Iowa Womens Health Study K Saag, J Cerhan, L Merlino, L Criswell, T Mikuls, M Burma, A Mudano, A Folsom. Alabama, Minnesota, Iowa, California.
Objective: Objective: To evaluate the relationship of cigarette smoking to the development of rheumatoid arthritis in the elderly.
Method: The investigators examined this relationship among 158 women who developed rheumatoid arthritis in comparison to 31,178 free of disease during the follow-up period. The diagnosis of rheumatoid arthritis was either made by the participants rheumatologist (88% of cases) and/or satisfied ACR criteria (92% of cases).
Results: The mean age, at onset of rheumatoid arthritis, was 68 years. Compared to the never smokers of cigarettes, the former smokers were at modest increased risk (relative risk 1.27) and the current smokers were at substantially increased risk (relative risk 1.97) of developing rheumatoid arthritis. Adjustment for potential confounders did not alter these results.
Editorial Comments:These results are intriguing and impressive. Though this study does not suggest a biologic mechanism that might mediate this apparent relationship, the results do suggest that avoidance of cigarette smoking, in addition to its other known health benefits, may also diminish ones risk of developing rheumatoid arthritis.
