The effect of symptomatic extra-articular manifestations of rheumatoid arthritis on disease activity and patient-reported outcomes: a cross-sectional and observational study.

introductionRheumatoid arthritis (RA) is a chronic inflammatory disease that primarily affects the joints but also has extra-articular manifestations. Extra-articular manifestations (EAMs) in RA encompass a wide range of clinical findings that may significantly affect patients' quality of life. This study aimed to compare daily life, social function, and work productivity between RA patients with and without EAMs. In this study, we aimed to determine the differences in daily life, social life, and work between patients with and without EAM.

methodsThis cross-sectional and observational study included 402 RA patients (2010 ACR-EULAR). EAM was defined as systemic symptoms and organ involvement occurring outside of the joint findings caused by RA. The presence of EAM was grouped as symptomatic/asymptomatic. Patients were evaluated once during the study period in an outpatient setting. Patients completed the Health Assessment Questionnaire (HAQ), Short Form-36 (SF-36), and Work Productivity and Activity Impairment: General Health (WPAI: GH) forms under clinician observation. Continuous variables were compared using the Mann-Whitney U test and Independent Samples T-test, while Fisher's exact test or chi-square test was used for categorical variables. The significance level was set at 5% (p < 0.05).

resultsThe study included 402 patients. 325 (80.8%) were female, with a median (IQR) age of 56 (47-64.25) and a mean±standard deviation (SD) disease duration of 9.7 ± 8.6 years. EAM was present in 200 patients. Patients were classified as having symptomatic EAM (sEAM) (n = 81), asymptomatic EAM (asEAM) (n = 119), and no EAM (n = 202). The median age was 60 (54.5-67), and the median age at diagnosis was 49 (39.5-58) in the sEAM group, which had the highest values (p:<0.001 and p:0.003, respectively). Peripheral neuropathy detected in 24 (29.6%) patients was the most common symptomatic EAM, while keratoconjunctivitis sicca detected in 44 (36.9%) patients was the most common asymptomatic EAM. In sEAM patients, HAQ mean ± SD was 0.92 ± 0.73, while in non-EAM patients it was 0.68 ± 0.65, p = 0.021. In SF-36 results, physical function, social function, role physical, vitality, and mental health were statistically significantly lower in patients with sEAM compared to other groups. The percentage of working patients was higher at 28.2% in those without EAM, p:0.010. Absenteeism, mean ± SD, was higher in the sEAM group at 12.8 ± 28.1, p: 0.037, and activity impairment was also higher in sEAMs at mean ± SD 44.2 ± 29.1, p:0.025.

conclusionsRegardless of RA disease activity, patients with sEAM experience negative impacts on both their daily and social lives as well as their work life. Symptomatic EAMs are associated with significant impairment in quality of life and work productivity, independent of traditional disease activity measures. Clinicians should therefore systematically assess and manage these manifestations as an integral component of RA care.