THU0175 Extra-Articular Manifestations of Rheumatoid Arthritis Develop in Patients Receiving Anti-TNF Treatment - A Retrospective Study
Authors: A.-F.F. Negoescu, S.M. Abraham
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Morbidity and mortality in patients with rheumatoid arthritis (RA) are mainly increased by extra-articular manifestations (EA-RA). Studies have suggested that only RA patients with systemic manifestations, as opposed to RA patients without systemic manifestations, have an increased mortality when compared with the general population.[1, 2] <h3>Objectives</h3> To assess the development of extra-articular manifestations of rheumatoid arthritis (RA) - lung disease, renal disease, nodules and vasculitis - in patients receiving anti-TNF treatment. <h3>Methods</h3> 152 patients with an established diagnosis of RA, who have received anti-TNF therapy (Infliximab, Etanercept, Adalimumab) were randomly selected from the Charing Cross Hospital (London, UK) Rheumatology department database. <h3>Results</h3> 110 patients (72.8%) never had extra-articular manifestations of RA, whereas 42 patients (27.2%) did have one of the mentioned extra-articular manifestations of RA before or after commencing anti-TNF therapy. This represents a very high percentage compared to the prevalence of the EA-RA among the RA population previously reported in studies (8-12%).[1-4] Only women developed lung disease, renal impairment or vasculitis, but this could be due to the high prevalence of RA among female population rather than a higher risk for extra-articular manifestations' development in women. In 22 cases (14.47%), <b>a new extra-articular manifestation developed after starting anti-TNF</b> (8 cases of lung disease; 11 cases of rheumatoid nodules; 3 cases of vasculitis). In 5 cases, there was clear evidence of progression of pre-existing EA-RA (2 lung disease, 3 nodules). Regression was found in 4 cases of nodular RA. Renal disease was found in just one case, and it had a stable evolution throughout the whole anti-TNF treatment period. In the rest of the cases, the evolution of EA-RA remains unclear. The incidence rate of new onset of EA-RA was 7.5 cases per 1000 person-years, which gives a risk of developing new EA-RA of 2.73 cases per person-year. When relating to period of exposure to anti-TNF, the risk was 6.57 cases per person-year. <h3>Conclusions</h3> Flares and extra-articular disease are still present in patients treated with anti-TNF. In some of the cases, this is due to treatment failure, because of high activity of the disease. In other cases, the development of extra-articular manifestations may be associated with the use of anti-TNFs. <h3>References</h3> Turesson C, O'Fallon WM, Crowson CS, et al. Occurrence of extraarticular disease manifestations is associated with excess mortality in a community based cohort of patients with rheumatoid arthritis. <i>J Rheumatol.</i> 2002;29:62-67. Turesson C, Jacobsson LT. Epidemiology of extra-articular manifestations in rheumatoid arthritis. <i>Scand J Rheumatol.</i> 2004;33:65-72. Turesson C, Eberhardt K, Jacobsson LT, et al. Incidence and predictors of severe extra-articular disease manifestations in an early rheumatoid arthritis inception cohort. <i>Ann Rheum Dis.</i> 2007;66:1543-1544. Lindqvist E, Saxne T, Geborek P, et al. Ten year outcome in a cohort of patients with early rheumatoid arthritis: health status, disease process, and damage. <i>Ann Rheum Dis.</i> 2002;61:1055-1059. <h3>Acknowledgements</h3> Sister Angela Smith designed the database. Marie Kelleher provided the hospital notes for the randomised cases. Michael Soljak and Hillary Watt helped with statistical advice. <h3>Disclosure of Interest</h3> None Declared