Pattern of Rheumatoid Arthritis in Minia Governorate

Background: Rheumatoid arthritis is a chronic systemic autoimmune disease. It is characterized by 
destruction of bone and cartilage, persistent synovitis and chronic disability that leads to structural 
joint damage causing deformity. Aim of the work: Was to assess pattern of rheumatoid arthritis at 
Minia governorate regarding disease presentation, disease activity, severity, disease remission, drug 
use and extraarticular manifestations. Methods: One hundred rheumatoid arthritis (RA) patients were 
included in this study, subjected to history taking, clinical examination and laboratory investigations. 
Assessment of disease activity was done using disease activity score. Disease disability was assessed 
by modified health assessment questionnaire and functional status by American College of 
Rheumatology criteria for functional status. Disease severity was assessed by simple erosion 
narrowing score and musculoskeletal ultrasound. Results: This study included 100 patients (75% 
females and 25% males). Their ages ranged from 18 to 63 years with a mean of 42.32 ± 12.13. Age at 
onset of rheumatoid arthritis: ranged from 18-50 years with a mean of 35.711.8. Disease duration 
ranged from 1-25 years with a mean of 7.75±5.96. Duration of morning stiffness ranged from 0 to 180 
min. with a mean of 74.94 ± 46.53. The commonest joint affected was metacarpophalangeal joint in 
88% of rheumatoid arthritis patients, while the least affected joints were sternoclavicular joint and 
acromiclavicular joint were affected in 5% of rheumatoid arthritis patients. Secondary fibromyalgia 
was the commonest extra articular manifestation in 14% of rheumatoid arthritis, while Raynaud's 
phenomenon was present in only 2% of our patients. The most common used drug was 
hydroxychloroquine in 91% of RA patients, followed by methotrexate in 63% of rheumatoid arthritis 
patients. Regarding laboratory findings: rheumatoid factor was positive in 61% of rheumatoid arthritis 
patients, Anti citrullinated peptide antibodies was positive in 62% and C-reactive protein was positive 
in 65%. Simple erosion narrowing scale ranged from 0-29 with a mean of 12.82±5.98, erosion count 
ranged from 0-15 with a mean of 5.96± 3.18, joint space narrowing count ranged from 0-18 with a 
mean of 6.92±3.99, 65% of patients were class II of functional status and 66% had moderate score of 
modified health assessment questionnaire, 57% of RA patients had moderate disease activity score. 
Regarding ultrasound disease activity score parameters, synovial hypertrophy was present in all of our 
patients (100%) and erosion was present in 84%. Higher disease activity score affected in late onset 
rheumatoid arthritis patients more than young onset rheumatoid arthritis patients, but erosions more in 
young onset rheumatoid arthritis patients, sever modified health assessment questionnaire more in 
young onset rheumatoid arthritis group. As regard to sex the study showed females patients had more 
active and more disabling than males, eroions were more in males. Conclusion: In Minia governorate, 
rheumatoid arthritis was more common in middle aged females, most patients had insidious onset and 
moderate disease activity, MCPs were the most commonly affected joints, MTX and HCQ were the 
most widely used treatment. Late onset rheumatoid arthritis had higher disease activity score, less 
disabling and less erosive disease than young onset rheumatoid arthritis. Female patients had more 
active, more disabling and more erosive disease than males.