Interstitial lung disease and neuropathy as predominant extra-articular manifestations in patients with rheumatoid arthritis: a prospective study.
BACKGROUND
Rheumatoid arthritis (RA) patients with extra-articular manifestations (ExRA) have a severe course of the disease and higher mortality. Indian patients are considered to have a low prevalence of ExRA. We prospectively assessed ExRA in patients with rheumatoid arthritis from southern India.


METHODS
140 RA patients were qualified for the study. Patients with confounding factors were excluded. A detailed history and clinical examination was performed. Two independent investigators made a thorough search with relevant investigations for ExRA, according to well-defined criteria.


RESULTS
At least one ExRA was present in 36 patients (25.7%). The predominant ExRA (9.29%) was Interstitial Lung Disease (ILD). 12 patients had neuropathy (8.57%). 5 patients had eye involvement, while 3 had cutaneous vasculitis. 4 patients had rheumatoid nodules, and 1 had amyloidosis. The median age at diagnosis and duration of disease were significantly higher in patients with ExRAs than in those without. Deformities and the use of steroids were more common in the ExRA cohort.


CONCLUSIONS
The present study shows a high prevalence of ILD and neuropathy as ExRAs in our population. A more extensive investigative protocol is warranted for picking up milder presentations of these serious manifestations.
Bharadwaj
Anurag
A
Department of Immunology, Rheumatology, Charaka Express, Kasturba Medical College, Manipal, Udupi District, Karnataka, India. Anurag_Bharadwaj@hotmail.com
Haroon
Nigil
N
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000503:physiopathology*; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000503:physiopathology; D017563:Lung Diseases, Interstitial / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000503:physiopathology*; D011446:Prospective Studies