Extra-articular manifestations of rheumatoid arthritis: a hospital-based study

The frequency of extra-articular manifestations in rheumatoid arthritis (ExRA) differs from one country to another, so we investigated ExRA frequency in a well-defined hospital patient population with rheumatoid arthritis (RA) in Saudi Arabia. We also examined possible predictors of the development ExRA.

A retrospective analysis was conducted of all patients diagnosed with RA at a university hospital during a 4-year period. Cases were classified according to the 1987 American College of Rheumatology criteria for RA, and the frequency of ExRA was recorded.

Of 140 patients who fulfilled the criteria for the diagnosis of RA, 98 (70%) developed ExRA features. Anemia occurred in 61%, thrombocytosis in 16%, pulmonary involvement in 10%, and renal amyloidosis, vasculitis and Felty syndrome were present in 6%, 2% and 1%, respectively. The mortality rate was high (16%) in patients with ExRA. The predictors for mortality were lung involvement, age over 50 years and kidney amyloidosis.

ExRA were present in a substantial proportion of our patients, which lead to a worse disease outcome. Anemia, thrombocytosis and respiratory system involvement were the commonest. Early recognition and treatment are important to decrease mortality.