Factors Associated with Extra Articular Manifestations in Rheumatoid Arthritis


Rheumatoid arthritis
Extra articular


How to Cite

Ksir S, Akasbi N, Efemba K, El Aissaoui A, El Kinany K, Harzy T. Factors Associated with Extra Articular Manifestations in Rheumatoid Arthritis . Integr J Med Sci [Internet]. 2019 Nov. 26 [cited 2022 Oct. 5];6. Available from: https://www.mbmj.org/index.php/ijms/article/view/98


Introduction: Rheumatoid arthritis is a chronic, systemic and inflammatory joint disease that primarily affects the joints and can be associated with a variety of extra-articular manifestations. The aim of this study is to determine the frequency and the factors associated with those extra-articular manifestations.
Materials and methods: Cross-sectional study of hospitalized cases of rheumatoid arthritis in our department between January 2012 and January 2018. We studied the prevalence of the extra-articular manifestations and associated factors. The analysis was done by the software EPI INFO 3.5.4.
Results : 294 cases of rheumatoid arthritis included. The average age was 53.2 years +/- 12.3 with female predominance F / M = 6.1. The diagnosis lag time was 10.7 +/- 6.9 years. Half of our patients (50.7%) had systemic manifestations. In order of frequency, we distinguish: Osteoporosis (39.6%), Sjögren's syndrome (22.1%), pulmonary involvement (16.1%), dermatological manifestations (8.8%), cardiac involvement (8.8%), ocular involvement (3.1%) carpal tunnel syndrom (1.3%) and vasculitis (1.3%). The extra-articular manifestations were associated with several factors on bivariate analysis : advanced age (p = 0.014), longer duration of disease (p = 0.006), deformities (p = 0.000), seropositivity (p = 0.02), high titers of rheumatoid factor (p = 0.03), destruction (p = 0.02), bone erosions (p = 0.012) and non-use of biotherapy (p = 0.04). Factors whose association was statistically significant, after multivariate logistic regression analysis, were: advanced age (p = 0.04, OR = 1.02 [1.001-1.043], and longer duration of disease (p = 0.02 OR = 1.04 [1.005-1.082]).
Conclusion: In our Moroccan context, half of the patients with rheumatoid arthritis had extra-articular manifestations. Older patients with longer disease evolution are the most involved.



Dumusc A , So A. Complications et atteinte systémique de la polyarthrite rhumatoide. Rev Med Suisse 2014 ; 410 : 590-4. [Accessed 02 Jul 2021]. Available from : https://www.revmed.ch/revue-medicale-suisse/2014/revue-medicale-suisse-421/complications-et-atteintes-systemiques-de-la-polyarthrite-rhumatoide

Young A ,Koduri G. Extra-articular manifestations and complications of rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2007 Oct; 21(5): 907–27. https://doi.org/10.1016/j.berh.2007.05.007

Marcucci E, Bartoloni E, Alunno A, Leone MC, Cafaro G, Luccioli F, et Al. Extra-articular rheumatoid arthritis. Reumatismo. 2018 Dec 20; 70 (4): 212-224. https://doi.org/10.4081/reumatismo.2018.1106

Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS. et al. The American rheumatism association1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar; 31(3):315-24. https://doi.org/10.1002/art.1780310302

Villeneuve E, Nam J, Emery P. 2010 ACR-EULAR classification criteria for rheumatoid arthritis. Rev Bras Reumatol. Sep-Oct 2010; 50(5):481-3.

Schaeverbeke T, Truchetet ME, Richez C. Où et quand commence la polyarthrite rhumatoïde? Rev Rhumat. 2012 Nov;79(1):A13-17. https://doi.org/10.1016/S1169-8330(12)70055-8

Kishore S, Maher L, Vikas M. Rheumatoid vasculitis: a diminishing yet devastating menace. Curr Rheumatol Rep. 2017 Jul; 19(7): 39. https://doi.org/10.1007/s11926-017-0667-3

Marcella P, Vito R, Liboria D, Angelo V, Franco DFederico P. Extra-articular manifestations of rheumatoid arthritis: An update. Autoimmuni Revi. 2011 Dec; 11(2) 123-31. https://doi.org/10.1016/j.autrev.2011.09.001

Carmona L, Gonzalez-Alvaro I, Balsa A, Angel BM, Tena X, Sanmarti R. Rheumatoid arthritis in Spain: occurrence of extra-articular manifestations and estimates of disease severity. Ann Rheum Dis. 2003 Sep ;62(9):897–900. https://doi.org/10.1136/ard.62.9.897

Calguneri M, Ureten K, Akif OM, Onat AM, Ertenli I, Kiraz S, et al. Extra-articular manifestations of rheumatoid arthritis: results of a university hospital of 526 patients in Turkey. Clin Exp Rheumatol. May-Jun 2006; 24(3):305–8. [Accessed 02 Jul 2021]. Available from: https://www.clinexprheumatol.org/abstract.asp?a=2873

Turesson C, O'Fallon WM, Crowson CS, Gabriel SE, Matteson EL. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factorsover 46 years. Ann Rheum Dis. 2003 Aug;62(8):722–7. https://doi.org/10.1136/ard.62.8.722

Al-Ghamdi A, Attar SM. Extra-articular manifestations of rheumatoid arthritis: a hospital-based study. Ann Saudi Med. May-Jun 2009; 29(3): 189-193. https://doi.org/10.4103/0256-4947.51774

Turesson C, O’Fallon WM, Crowson CS, Gabriel SE, Matteson EL. Occurrence of extraarticular disease manifestations is associated with exccess mortality in a community based cohort of patients with rheumatoid arthritis. J Rheumatol. 2002 Jan; 29(1):62-7. [Accessed 02 Jul 2021]. Available from: https://www.jrheum.org/content/29/1/62.short

Harsha NS, Thimma Reddy SR, Madhuvan HS, Ravishankar SN. A study of extra-articular manifestations of rheumatoid arthritis. J Evid Based Med Healthc. 2017 Oct;4(81): 4783-4785. http://dx.doi.org/10.18410/jebmh/2017/955

Turesson C, Eberhardt K, Jacobsson LT, Lindqvist E. Incidence and predictors of severe extra-articular disease manifestations in an early rheumatoid arthritis inception cohort. Ann Rheum Dis. 2007 Nov; 6611):1543-4. https://doi.org/10.1136/ard.2007.076521

Richman NC, Yazdany J, Graf J, Chernitskiy V, Imboden JB. Extraarticular Manifestations of Rheumatoid Arthritis in a Multiethnic Cohort of Predominantly Hispanic and Asian Patients. Medicine (Baltimore). 2013 Mar; 92(2): 92–97. https://doi.org/10.1097/md.0b013e318289ce01

Calguneri M, Ureten K, Akif OM, Onat AM, Ertenli I, Kiraz S, et al. Extra-articular manifestations of rheumatoid arthritis: results of a university hospital of 526 patients in Turkey. Clin Exp Rheumatol. May-Jun 2006;24(3):305–8. [Accessed 02 Jul 2021]. Available from: https://www.clinexprheumatol.org/abstract.asp?a=2873

Nyhall-Wahlin BM, Petersson IF, Nilsson JA, Jacobsson LT, Turesson C. High disease activity disability burden and smoking predict severe extra-articularmanifestations in early rheumatoid arthritis. Rheumatology (Oxford). 2009 Apr;48(4):416–20. https://doi.org/10.1093/rheumatology/kep004

Myasoedova E, Crowson CS, Turesson C, Gabriel SE, Matteson EL. Incidence of extraarticular rheumatoid arthritis in Olmsted County, Minnesota, in 1995– 2007 versus 1985–1994: a population-based study. J Rheumatol. 2011Jun ; 38(6):983–9. https://doi.org/10.3899/jrheum.101133

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2019 Salma Ksir et al.


Download data is not yet available.