Changing trends in serious extra-articular manifestations of rheumatoid arthritis among United State veterans over 20 years. Rheumatology (Oxford) 2010 Sep;49(9):1670-5
Date
05/14/2010Pubmed ID
20463190Pubmed Central ID
PMC2919197DOI
10.1093/rheumatology/keq135Scopus ID
2-s2.0-77955752827 (requires institutional sign-in at Scopus site) 55 CitationsAbstract
OBJECTIVES: The purpose of this study was to examine prevalence trends of serious extra-articular manifestations (EAMs) in a data set representing both hospitalized and ambulatory patients with RA.
METHODS: This retrospective cohort study used serial cross-sectional data to examine the prevalence of serious EAMs in patients with RA from 1985 to 2006 across the United States (US) Veteran's Health Administration system. Serious EAMs included rheumatoid carditis, RA lung disease, FS and pooled EAM rates included previously reported vasculitis prevalence as queried by ICD-9 searches. Statistical analysis employed auto-regression and time series analysis using the Chow and Durbin-Watson tests to detect breakpoints and linear time-trends.
RESULTS: Among 3 million veterans, including >35,000 RA patients annually, we noted declining RA hospitalizations emphasizing the importance of examining both the inpatient and outpatient settings to assess EAM prevalence. Individual EAM trends varied, demonstrating linear declines in FS, increases in RA lung disease and significant breakpoint declines in carditis and pooled serious EAMs. Pooled EAM prevalence dropped around 2000, from an early linear trend peak of 10% among inpatients, to <7% among both inpatients and outpatients by 2006.
CONCLUSIONS: Overall, serious EAMs of RA have declined among US veterans in both the inpatient and outpatient settings, with the exception of RA lung disease likely reflecting improved detection. Breakpoints in pooled EAM prevalence appear to demonstrate consistent, true declines in severe RA extra-articular disease around 2000. Future work should explore the relationship between temporal EAM trends and specific RA therapies including adoption of biological agents.
Author List
Bartels CM, Bell CL, Shinki K, Rosenthal A, Bridges AJAuthor
Ann K. Rosenthal MD Associate Dean, Chief, Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Arthritis, Rheumatoid
Cardiovascular Diseases
Cohort Studies
Cross-Sectional Studies
Female
Hematologic Diseases
Humans
Inpatients
Lung Diseases
Male
Middle Aged
Outpatients
Retrospective Studies
Risk Factors
Statistics as Topic
United States
Veterans