title: Changing trends in serious extra-articular manifestations of rheumatoid arthritis among United State veterans over 20 years.
abstract: OBJECTIVE
  The purpose of this study was to examine prevalence trends of serious extra-articular manifestations (EAMs) in a data set representing both hospitalized and ambulatory patients with RA.
  
  
  METHODS
  This retrospective cohort study used serial cross-sectional data to examine the prevalence of serious EAMs in patients with RA from 1985 to 2006 across the United States (US) Veteran's Health Administration system. Serious EAMs included rheumatoid carditis, RA lung disease, FS and pooled EAM rates included previously reported vasculitis prevalence as queried by ICD-9 searches. Statistical analysis employed auto-regression and time series analysis using the Chow and Durbin-Watson tests to detect breakpoints and linear time-trends.
  
  
  RESULTS
  Among 3 million veterans, including >35,000 RA patients annually, we noted declining RA hospitalizations emphasizing the importance of examining both the inpatient and outpatient settings to assess EAM prevalence. Individual EAM trends varied, demonstrating linear declines in FS, increases in RA lung disease and significant breakpoint declines in carditis and pooled serious EAMs. Pooled EAM prevalence dropped around 2000, from an early linear trend peak of 10% among inpatients, to <7% among both inpatients and outpatients by 2006.
  
  
  CONCLUSIONS
  Overall, serious EAMs of RA have declined among US veterans in both the inpatient and outpatient settings, with the exception of RA lung disease likely reflecting improved detection. Breakpoints in pooled EAM prevalence appear to demonstrate consistent, true declines in severe RA extra-articular disease around 2000. Future work should explore the relationship between temporal EAM trends and specific RA therapies including adoption of biological agents.
authors.affiliation: Department of Medicine, Rheumatology section, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA. cb4@medicine.wisc.edu
authors.forename: Christie M
authors.initials: CM
authors.lastname: Bartels
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Bell
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Shinki
authors.forename: Ann
authors.initials: A
authors.lastname: Rosenthal
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Bridges
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000209:etiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006402:Hematologic Diseases / Q000209:etiology*; D006801:Humans; D007297:Inpatients; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D012189:Retrospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D014481:United States / Q000453:epidemiology; D014728:Veterans
references.citation: Rheumatology (Oxford). 2004 Jul;43(7):920-3
references.pmid: 15126674
references.citation: Clin Cornerstone. 2003;5(1):37-44
references.pmid: 12739310
references.citation: J Rheumatol. 2002 Jan;29(1):62-7
references.pmid: 11824973
references.citation: N Engl J Med. 2007 Nov 29;357(22):2277-84
references.pmid: 18046031
references.citation: Arthritis Rheum. 1997 Oct;40(10):1829-37
references.pmid: 9336418
references.citation: Rheumatol Int. 2000;19(6):213-7
references.pmid: 11063290
references.citation: Joint Bone Spine. 2008 Mar;75(2):215-8
references.pmid: 17977770
references.citation: J Chronic Dis. 1978;31(11):691-6
references.pmid: 730824
references.citation: Arthritis Rheum. 2004 Dec 15;51(6):952-7
references.pmid: 15593102
references.citation: Arthritis Rheum. 1997 Sep;40(9):1594-600
references.pmid: 9324013
references.citation: Arthritis Rheum. 2004 Nov;50(11):3729-31
references.pmid: 15529357
references.citation: J Am Coll Radiol. 2004 Aug;1(8):549-52
references.pmid: 17411652
references.citation: Thorax. 2001 Aug;56(8):622-7
references.pmid: 11462065
references.citation: Rheumatol Int. 1999;18(5-6):163-9
references.pmid: 10399790
references.citation: Arch Intern Med. 2008 Jan 28;168(2):159-66
references.pmid: 18227362
references.citation: Semin Arthritis Rheum. 1980 Aug;10(1):52-65
references.pmid: 7414334
references.citation: Ann Intern Med. 1985 Feb;102(2):169-75
references.pmid: 3966754
references.citation: Q J Med. 1969 Oct;38(152):397-423
references.pmid: 4242949
references.citation: Am J Public Health. 1991 Jul;81(7):865-9
references.pmid: 2053662
references.citation: Arthritis Rheum. 2009 Sep;60(9):2553-7
references.pmid: 19714622
references.citation: Rheumatology (Oxford). 2006 Aug;45(8):1048-9
references.pmid: 16760195
references.citation: Arthritis Rheum. 2004 Apr;50(4):1122-31
references.pmid: 15077294