Rheumatoid arthritis: a major disease burden

Objective: To determine frequency, demographics, laboratory parameters and disease severity in patients with Rheumatoid Arthritis. Methods: A retrospective analysis of prospectively collected data of patients with a diagnosis of Rheumatoid Arthritis, at the ‘Rheumatology Clinic’ of Jinnah Postgraduate Medical Centre, from February 2004 to February 2014. Detailed history, examination, laboratory investigations and treatment regimen were recorded in a pre-designed structured proforma. The demographic characteristics, deformities, extra-articular features, associated co-morbidities and disease severity were studied. Results: A total of 458 patients with the diagnosis of RA, were registered in our ‘Rheumatology Clinic’ during this period. Among these, 365(79.7%) were females and 93(20.3%) were males. The mean age of patients was reported to be 36.9±11.93 years, while the mean duration of joint pain was 3.49±2.1 years. Treatment regimen included mono-therapy in 131 (28.6%), dual therapy regimen in 221 (48.3%) and triple DMARDs therapy in 11 (2.40%) patients. DMARDs alone were used in 221 (48.3%), while 134 (29.3%) patients received DMARDs with maintenance dose steroids. Extra-articular manifestations were reported in 178 (38.86%) patients. Commonest co-morbidity was hypertension in 38(8.3%) patients. Additionally, out of the 287 patients who could be tested, 211 (73.5%) patients had vitamin-D deficiency as well. Conclusion: RA constitutes a significant rheumatological disease burden in our population. The demographic features and pattern of joint involvement is similar to the west, but a considerably younger population is affected in our region. The reason for this early disease occurrence needs to be explored. Vitamin-D deficiency may be a trigger in RA pathogenesis.