AB0389 EXTRA-ARTICULAR MANIFESTATIONS ARE FREQUENT IN SOUTH INDIAN PATIENTS WITH RHEUMATOID ARTHRITIS AND ARE INDEPENDENT OF THE DISEASE ACTIVITY OR SEROPOSITIVE STATUS.

Abstract

Background: Extra-articular manifestations are seen in around 40% of patients with Rheumatoid arthritis (RA) in western studies and increase the mortality in patients with RA [1]. There is a paucity of data from India, especially from South India on the prevalence and associations of extra-articular manifestations in RA. Objectives: To estimate the frequency of extra-articular manifestations (EAM) and their associations with disease characteristics in patients with Rheumatoid arthritis attending the Rheumatology clinic of a tertiary care teaching hospital in South India. Methods: A cross-sectional study of 316 consecutive patients fulfilling the 2010 ACR EULAR classification criteria of RA was done at a Rheumatology clinic in South India between October 2020 and December 2022. The various EAM studied were keratoconjunctivitis SICCA, Interstitial lung disease (ILD), pleuritis/ pleural effusion, bronchiectasis, small airway disease, pericarditis/ pericardial effusion, myocarditis, subcutaneous nodules, peripheral neuropathy, anaemia and Rheumatoid vasculitis. The comorbidities studied were diabetes mellitus, systemic hypertension, coronary artery disease, chronic obstructive pulmonary disease, hypothyroidism, and stroke. Various parameters like age, gender, disease duration, comorbidities, seropositivity, erythrocyte sedimentation rate (ESR), smoking, disease activity score (DAS28 ESR), and methotrexate use were compared between patients with EAM and those without EAM. Comparisons between groups were made with the chi-squared test when testing categorical variables and the Mann-Whitney U test or Independent samples' t test for continuous data. A binomial logistic regression analysis was also carried out to find the independent factors associated with EAM. Results: Among the 316 patients, 272 were female (86.1%). The mean age of the study population was 51.6 ± 11.38 years and the median disease duration was 36 months (84). 141 patients (44.6%) had at least one comorbidity and 23 patients (7.3%) were current or former smokers. 264 patients (84.1%) were Rheumatoid factor (RF) positive and 298 patients (94.6%) were cases of seropositive RA (RF and/or Anti CCP positive) The median ESR was 50 mm/ hour and the median DAS 28 ESR was 4.65. 164 patients (51.9%) were methotrexate naïve. At least one EAM was seen in 134 patients (42.4%) and the most frequently seen EAM was anaemia (48 patients, 15.2%). Keratoconjunctivitis SICCA was seen in 32 patients (10.1%) and symptomatic ILD was seen in 30 patients (9.5%). Rheumatoid vasculitis was seen in 20 patients (6.3%). Age, disease duration, and ESR (table 1) were found to have significant association with extra-articular manifestations by univariate analysis. On binomial logistic regression, disease duration (p=0.002) and ESR (p=0.047) were found to have a significant association with the presence of extra-articular manifestations. Conclusion: Extra-articular manifestations were seen in a significant proportion of our RA patients irrespective of the seropositivity status, disease activity, or methotrexate use and had a positive association with disease duration and ESR. (Table Presented).