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Clinical Investigation| Volume 365, ISSUE 4, P337-344, April 2023

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Disease profile of rheumatoid arthritis and its complications in hispanic population

Published:January 04, 2023DOI:https://doi.org/10.1016/j.amjms.2022.12.029

      Abstract

      Background

      Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease that is associated with functional disability and reduced quality of life. The central pathology of RA is the inflammation of diarthrodial joints, but approximately 40% of patients experience extra-articular manifestations of RA. Extra-articular manifestations are complications of RA that constitute multisystem disorders, associated with genetic and environmental conditions, and increase mortality in RA patients. Observational studies of RA patients have suggested ethnic disparities exist for minority populations; however, less is known about the distribution and prevalence of RA complications and drug-related problems (DRPs). Our objective was to construct a disease profile of RA-related complications in the Hispanic Mexican-American population compared to the non-Hispanic population of El Paso, Texas.

      Methods

      A retrospective study was conducted in a Texas Tech University Health Science Center El Paso from 2009 to 2019 to assess the prevalence of RA-related complications in the Hispanic vs non-Hispanic population. The primary parameters were RA diagnosis, serological status, RA-treatment modalities, and history of associated complications. Data were extracted by chart review and correlated to disease-related and treatment-related complications. STATA was used to perform statistical analyses. A p-value of < 0.05 determined statistical significance.

      Results

      One thousand five hundred five (N=1505) patients, diagnosed with RA, were included in this study. Of the cohort, 82.52% of patients were females, 76.81% were Hispanic, and 64.12% had no smoking history. From the total cohort, seven hundred fifty-six (N=756) patients had documentation of serological markers (Rheumatoid factor (RF) and/or Anti-cyclic citrullinated peptide (Anti-CCP)); 78.44% of patients whose serological status was documented, were positive for RF and/or Anti-CCP. Multivariate regression analysis revealed Hispanics have 15% and 17% less risk of overall RA complications and drug-related side-effects, respectively, compared to non-Hispanics (p-value <0.0001). However, within the entire cohort, those with a family history of RA had a 44% more risk of complications compared to those without family history (p-value <0.0001). Additionally, modifiable risk factors, i.e., active smoking and alcohol use had a higher complication risk, 19% and 21%, respectively (p-value <0.0001). Significantly, all patients seropositive for RF, and/or anti-CCP had a lower prevalence of RA-related and drug-related complications. However, non-Hispanic patients seropositive for RF or anti-CCP had a higher prevalence of specific complications of RA and DRPs compared to Hispanic patients.

      Conclusion

      In our retrospective review, analysis of sociodemographic characteristics reveals that Hispanic patients paradoxically have less risk of disease-related and treatment-related complications compared to non-Hispanic populations in El Paso, Texas. Genetic predisposition, modifiable environment/lifestyle factors had a higher prevalence of RA complications, congruent with established studies. Further analysis reveals that seropositive RA-patients have decreased complication prevalence compared to seronegative cohorts.

      Key Indexing Terms

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      References

        • Chauhan K
        • Jandu JS
        • Goyal A
        • Bansal P
        • Al-Dhahir MA.
        Rheumatoid Arthritis.
        Rosen Barkin's 5-Minute Emerg Med Consult. Fifth Ed. 2021https://doi.org/10.1017/chol9780521332866.074 (Published online October 7)
        • Kim JW
        • Suh CH.
        Systemic manifestations and complications in patients with rheumatoid arthritis.
        J Clin Med. 2020; 9: 1-5https://doi.org/10.3390/JCM9062008
        • Marcucci E
        • Bartoloni E
        • Alunno A
        • et al.
        Extra-articular rheumatoid arthritis.
        Reumatismo. 2018; 70: 212-224https://doi.org/10.4081/REUMATISMO.2018.1106
        • Cojocaru M
        • Cojocaru IM
        • Silosi I
        • Vrabie CD
        • Tanasescu R.
        Extra-articular manifestations in rheumatoid arthritis.
        Mædica. 2010; 5: 286https://doi.org/10.14412/1995-4484-2018-356-362
        • Deane KD
        • Demoruelle MK
        • Kelmenson LB
        • Kuhn KA
        • Norris JM
        • Holers VM.
        Genetic and environmental risk factors for rheumatoid arthritis.
        Best Pract Res Clin Rheumatol. 2017; 31: 3https://doi.org/10.1016/J.BERH.2017.08.003
        • Jiang X
        • Alfredsson L.
        Modifiable environmental exposure and risk of rheumatoid arthritis - current evidence from genetic studies.
        Arthritis Res Ther. 2020; 22: 1-10https://doi.org/10.1186/S13075-020-02253-5/TABLES/2
        • Wu CY
        • Yang HY
        • Luo SF
        • Lai JH.
        From rheumatoid factor to anti-citrullinated protein antibodies and anti-carbamylated protein antibodies for diagnosis and prognosis prediction in patients with rheumatoid arthritis.
        Int J Mol Sci. 2021; 22: 1-18https://doi.org/10.3390/IJMS22020686
        • Miriovsky BJ
        • Michaud K
        • Thiele GM
        • et al.
        Anti-CCP antibody and rheumatoid factor concentrations predict greater disease burden in U.S. veterans with rheumatoid arthritis.
        Ann Rheum Dis. 2010; 69: 1292https://doi.org/10.1136/ARD.2009.122739
        • Conforti A
        • Di Cola I
        • Pavlych V
        • et al.
        Beyond the joints, the extra-articular manifestations in rheumatoid arthritis.
        Autoimmun Rev. 2021; 20102735https://doi.org/10.1016/J.AUTREV.2020.102735
        • Figus FA
        • Piga M
        • Azzolin I
        • McConnell R
        • Iagnocco A.
        Rheumatoid arthritis: extra-articular manifestations and comorbidities.
        Autoimmun Rev. 2021; 20102776https://doi.org/10.1016/J.AUTREV.2021.102776
        • Xu Y
        • Wu Q.
        Prevalence trend and disparities in rheumatoid arthritis among us adults, 2005–2018.
        J Clin Med. 2021; 10: 3289https://doi.org/10.3390/JCM10153289/S1
        • Barton JL
        • Trupin L
        • Schillinger D
        • et al.
        Racial and ethnic disparities in disease activity and function among persons with rheumatoid arthritis from university-affiliated clinics.
        Arthritis Care Res (Hoboken). 2011; 63: 1238https://doi.org/10.1002/ACR.20525
        • Yazici Y
        • Kautiainen H
        • Sokka T.
        Differences in clinical status measures in different ethnic/racial groups with early rheumatoid arthritis: implications for interpretation of clinical trial data.
        J Rheumatol. 2007; 34 (LP - 315): 311
        • Bruce B
        • Fries JF
        • Murtagh KN.
        Health status disparities in ethnic minority patients with rheumatoid arthritis: a cross-sectional study.
        J Rheumatol. 2007; 34 (LP - 1479): 1475
        • Greenberg JD
        • Spruill TM
        • Shan Y
        • et al.
        Racial and ethnic disparities in disease activity in rheumatoid arthritis patients.
        Am J Med. 2013; 126: 1089https://doi.org/10.1016/J.AMJMED.2013.09.002
        • Molina E
        • Haas R
        • Del Rincon I
        • Battafarano DF
        • Restrepo JF
        • Escalante A.
        Does the “hispanic paradox” apply to rheumatoid arthritis? Survival data from a multi-ethnic cohort.
        Arthritis Care Res (Hoboken). 2014; 66: 972https://doi.org/10.1002/ACR.22254
        • 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; 92: 92https://doi.org/10.1097/MD.0B013E318289CE01
      1. Boytsov N, Lilly E, Schroeder KM. Prevalence of rheumatoid arthritis in the United States adult population in healthcare claims databases, 2004–2014. Published online 2004. doi:10.1007/s00296-017-3726-1

        • Turesson C
        • O'Fallon WM
        • Crowson CS
        • Gabriel SE
        • Matteson EL
        Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years.
        Ann Rheum Dis. 2003; 62: 722https://doi.org/10.1136/ARD.62.8.722
        • Kobak S.
        Demographic, clinical, and serological features of Turkish patients with rheumatoid arthritis: Evaluation of 165 patients.
        Clin Rheumatol. 2011; 30: 843-847https://doi.org/10.1007/s10067-011-1678-5
        • KIM S-K
        • PARK S-H
        • SHIN I-H
        • CHOE J-Y
        Anti-cyclic citrullinated peptide antibody, smoking, alcohol consumption, and disease duration as risk factors for extraarticular manifestations in korean patients with rheumatoid arthritis.
        J Rheumatol. 2008; 35 (LP - 1001): 995