VIENNA — Early rheumatoid nodules, pulmonary involvement, and malaise with weight loss are predictive of long-term poor outcomes in rheumatoid arthritis, Gouri Koduri, M.D., said at the annual European Congress of Rheumatology.
Although rheumatoid arthritis (RA) is primarily an articular disease, it also has myriad extraarticular manifestations, some of which are associated with increased morbidity and mortality. But there have been few reports on when in the course of disease these extraarticular features develop and what their impact is, she said.
These concerns are now being addressed in an ongoing inception cohort that includes 1,415 patients who have been enrolled since 1986 from nine centers in England.
Clinical and laboratory measures have been recorded at yearly intervals, and analyses of 10-year outcomes include function disability, joint damage, and causes of death.
The effects of other parameters such as age, sex, rheumatoid factor (RF) positivity, and smoking on the development of extraarticular manifestations also have been examined, said Dr. Koduri of St. Albans City Hospital, Hertfordshire (England) University.
A total of 576 (41%) patients have had at least one extraarticular feature. The most common were subcutaneous nodules, in 450 patients (34%). These developed within the first year after diagnosis in 11%, she said at the congress, sponsored by the European League Against Rheumatism.
Secondary Sjögren's syndrome developed in 140 (10%), pulmonary disease in 55 (4%), marked malaise and weight loss in 47 (3%), and vasculitis in 32 (2%).
Risk factors for mortality included pulmonary fibrosis, with an odds ratio of 6.93, and the presence of two or more extraarticular features at presentation or by 1 year after diagnosis, with an odds ratio of 4.3, she said.
Marked malaise with weight loss and rheumatoid nodules also were associated with increased risk of mortality, with odds ratios of 2.7 and 1.5, respectively.
Extraarticular manifestations were a primary or contributory cause of death in 24 patients, 23 with pulmonary fibrosis and 1 with vasculitis, Dr. Koduri said.
The presence of nodules within the first 2 years also was predictive of morbidities including erosive disease, with an odds ratio of 2.7, and poor physical function, with an odds ratio of 1.6.
Sjögren's syndrome was associated only with worse function.