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Raynaud's phenomenon secondary to rheumatoid arthritis may be predictive of more erosive disease
Arthritis Res Thervolume 6, Article number: 75 (2004)
Raynaud's phenomenon (RP) occurs less frequently in rheumatoid arthritis (RA) than with other connective tissue diseases, such as scleroderma and systemic lupus erythematosus. We studied the relationship between RP and other disease characteristics common to RA to determine whether RP can be predictive of more severe disease. Secondary analyses were preformed to assess correlations between other antibodies/manifestations that occur in RA, and the onset of RP versus RA disease duration.
Using a standardized assessment, data were collected on a cross-sectional cohort of RA subjects (n = 329; mean age 60.3 ± 0.7 years; 77% female; 76% erosions, 75% positive rheumatoid factor [RF]) who met the American College of Rheumatology criteria for RA and had been seen at a London, Ontario rheumatology clinical practice during the 6-month study period. Study participants were prevalent (follow-up) cases and new referrals. A subsequent chart review was performed to verify clinic data and also to collect data on all variables that were not available at the time of the clinic visit. RP was defined as pallor of the fingers along with rubor, cyanosis, or both.
The mean disease duration was 12 ± 0.6 years. Seventy patients (22%) had RP. RP status was not related to gender, age, or disease duration. The mean age at onset of RP was 50.7 ± 2 years and the mean RP duration was 9.2 ± 1.5 years. Patients presented with RP a mean of 3.8 ± 1.4 years after the diagnosis of RA (95% confidence interval, 0.9–6.6 years; minimum, maximum = 31 years before RA diagnosis, 32 years after). RP status was not associated with the presence of nodules and erosions. Patients with sclerodactyly [all was distal to proximal interphalangeal joints] were more likely than those without to have RP (34% versus 17%, P < 0.001). Subjects with sclerodactyly (26%) were also more likely than those without to have erosions (86% versus 72%, P < 0.02). Patients who developed RP after their RA diagnosis were more likely to have erosions than those who developed RP before RA (P < 0.005). As expected, positive RF was associated with longer disease duration (P < 0.04). Higher RF values were associated with longer disease duration (P < 0.005) and increased RP duration (P < 0.01).
RP was present in 22% of the RA patients seen in a rheumatology clinical practice in London, Ontario during the 6-month study period. RP appears to develop relatively soon (approximately 1–7 years) after RA diagnosis in the majority of cases. Idiopathic RP may be different from RP secondary to RA, the latter of which may be associated with more erosive RA. Sclerodactyly is associated with erosive arthritis and RP in RA. Higher RF values were indicative of increased RA and RP duration.