Background Rheumatoid arthritis (RA) is one of the commonest autoimmune diseases. It affects about 1% of the population worldwide (1). The prevalence of RA varies widely between different countries (2). Not only the prevalence of the disease which differs among different continents, races, ages and socioeconomic levels but also the disease pattern. Studies explaining the epidemiology of RA in Egypt in general and in upper-Egypt, in particular, are very limited (3).
Objectives To estimate the comorbidity of rheumatoid arthritis and its relation to disease activity, duration, disease pattern and demographic features of RA patients in upper Egypt.
Methods This study was carried out on 923 patients who fulfilled ACR/EULAR criteria 2010. All of them live in Sohag governorate and aged 18 years or older DAS28-ESR score, first involved joint, joint distribution, disease pattern, extra-articular comorbidities including gastrointestinal, urinary, cardiac, haematological and neurological were estimated. The activity of daily living was valued by Erlangen score (E-ADL).
Results The mean age of the participants was 45±10.9 years, with a range (19–70). The median of the disease duration was 5 years, with a range (0.5–40 years). Most of the participants were female (691, 74.9%). Disease onset was gradual or insidious in 94.3% of cases and acute in 5.7% of them. First joint group affected were the small joints of the hands (MCPs and PIPs), recorded in 48.9% of cases, Followed by wrist joints (29.3% of cases), then knees (9%), ankles and small joints of the foot (6%) and lastly other joints collectively recorded in only 6.8%. The commonest extra-articular comorbidities were haematological, seen in 323 cases; 35%, followed by gastrointestinal in 290 cases (31.4%), then ophthalmological in 31%, entrapment syndromes in 29.4%, pulmonary in 21.7%, urological in 12.4%, rheumatoid nodules in 11.4%, liver cirrhosis in 8.7%, renal impairment in 8.5% and Cardiovascular diseases in 6.5%. The activity of daily living (E-ADL) showed that most of the cases fell in score 4 (58.2%). Regarding DMARDs treatment of the study population, Methotrexate (MTX) was used regularly by 78.3% of cases, hydroxychloroquine (HCQ) by 78.1%, followed by Leflunomide (LEF) by 26.4% and sulfasalazine (SSZ) by 13.1%. The majority of cases used combination therapy of either MTX+HCQ, MTX+SSZ, MTX+HCQ+SSZ or MTX+LEF. Regarding other drugs, 99% of cases used NSAIDs (regularly in 30.2% and on demand in 68.8%). Steroids were regularly used by 28.8% of cases.
Conclusions The commonest comorbidities were haematological, gastrointestinal, ophthalmological and neurological ones; respectively. Erosion, deformity and Das28-ESR score have a great impact on E-ADL score.
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Ferucci ED, Templin DW, Lanier AP, editors. Rheumatoid arthritis in American Indians and Alaska Natives: a review of the literature. Seminars in arthritis and rheumatism; 2005: Elsevier.
El-Labban AS, Omar HAA, El-Shereif RR, Ali F, El-Mansoury TM. Pattern of young and old onset rheumatoid arthritis (YORA and EORA) among a group of Egyptian patients with rheumatoid arthritis. Clinical medicine insights Arthritis and musculoskeletal disorders. 2010;3:25.
Disclosure of Interest None declared
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