Delayed referral, socioeconomic status, and disease characteristics as factors associated with disabilities in...

This study aims to identify factors associated with higher Rheumatoid Arthritis Articular Damage (RAAD) scores in rheumatoid arthritis (RA) patients and to evaluate correlations between disease duration, joint involvement, extra-articular manifestations, and functional outcomes with the severity of articular damage.

This multicenter, cross-sectional study was conducted across 8 tertiary care centers in India using the Indian Rheumatology Association database (2019-2022). Patients fulfilling the 2010 ACR/EULAR RA criteria were included. Demographic, clinical, socioeconomic, comorbidity, and disease-specific variables were collected. Articular damage was assessed using the RAAD score. Logistic regression was performed to identify predictors of damage.

Of 4641 recruited patients, 4213 were analyzed (mean age 52.8 years; 87.6% female). Severe damage was observed in 9%, moderate in 9.2%, and absent in 81.9%. Patients with severe damage had longer disease duration (median 13 vs. 8 years; p<0.001), more frequent extra-articular (10.3%) and systemic features (7.9%), and greater functional disability (mean health assessment questionnaire 11.12 vs. 3.96; p<0.001). Logistic regression identified longer disease duration [odds ratio (OR) 1.008, p<0.001], higher visual analog scale pain (OR 1.054, p=0.009), physician (OR 1.134, p=0.004) and patient global assessments (OR 1.224, p<0.001), extra-articular features (OR 2.885, p<0.001), and systemic features (OR 4.935, p<0.001) as independent predictors of joint damage.

Severe joint damage is associated with delayed presentation, higher disease activity, and extra-articular/systemic features. Socioeconomic factors and comorbidities also influence outcomes. Early referral and comprehensive management are essential to reduce long-term disability in RA.