RESUMO
Objectives: To describe the prevalence of rheumatoid nodules [RN] in patients with rheumatoid arthritis [RA] and to compare their features with those of patients without RN
Subjects and Methods: Adult RA patients [n = 952] in the Kuwait Registry for Rheumatic Diseases from February 2013 to December 2015 were evaluated for RN. Demographic and serological features and disease activity and severity were obtained from the registry
Results: Of the 952 RA patients, 22 [2.3%] had RN and 930 [97.7%] did not. Age, sex, disease duration, smoking, and family history of an autoimmune rheumatic disease were similar. Obesity was more prevalent in the RN group, i.e. 11 [50%] vs. 326 [35.1%], p = 0.016. There was no difference in rheumatoid factor [RF] or anti-cyclic citrullinated peptide antibody positivity. Patients with RN had more sicca symptoms, i.e. 8 [36.4%] vs. 152 [16.3%], p = 0.025, a higher mean score on the visual analogue scale pain [3 +/- 2.9 vs. 2 +/- 2.7, p < 0.001], more tender joints [6.4 +/- 8.8 vs. 4.2 +/- 7.2, p = 0.001], a higher patient global assessment of disease activity [3.3 +/- 2.7 vs. 2.3 +/- 2.7, p < 0.001], and more deformities, i.e. 3 [13.6%] vs. 74 [8%], p = 0.034. The mean health assessment questionnaire score in RN patients was 1.1 versus 0.9 in patients without RN [p = 0.08]. Patients with RN had a low disease activity [means: disease activity score [DAS-28], 3.02; clinical disease activity index, 7.7; and simple disease activity index, 10.4], similar to the other group. While the rates of methotrexate treatment were comparable, biologic therapy was administered more in patients with RN [i.e. 15 [68.2%] vs. 478 [51.4%], p < 0.001]
Conclusion: In Kuwait, the prevalence of RN is low among RA patients. Patients with and without RN are similar in terms of demographics and serologic features, except for more obesity. However, patients with RN have more sicca symptoms, joint deformities, and painful and tender joints. Disease activity scores are low with more frequent biologic therapy
RESUMO
The WHO-ILAR Community Oriented Program for Control of Rheumatic Diseases [COPCORD] primarily aims to estimate the burden of musculoskeletal symptoms/disorders. We estimated the incidence of musculoskeletal pain in the first community-based COPCORD study in Kuwait. The validated Arabic version of the WHOILAR COPCORD Core Questionnaire was used in a survey of 2500 randomly selected Kuwaiti households to assess the frequency of musculoskeletal pain, disability, and health-seeking behavior in adult Kuwaitis. Those subjects reporting no musculoskeletal pain were identified and followed-up for a period of one year by contacting them every 2 weeks. Once a respondent reported pain, an appointment to report to hospital was offered and the subject was examined by a rheumatologist using American College of Rheumatology [ACR] criteria. Of 5159 adults who were non-complainers in an earlier prevalence phase of the study, 3341 responded to phone calls [response rate of 65%]. The incidence of musculoskeletal pain was 6.6% [95%CI, 3.4%- 9.7%]. Age- and sex-adjusted incidence rates were 7.2% [95%CI, 3.4%- 10.5%] for females and 6.1% [95%CI, 3.1%-9.2%] for males. The incidence rate increased with increasing age, body mass index, and with being married. The common sites of pain were knee, low back and shoulder. The incidence of musculoskeletal pain among Kuwaiti adults is reported for the first time. Further studies adopting the same instrument in other communities are warranted to compare with our findings