Characteristics of rheumatoid arthritis patients at first presentation to a specialized rheumatology department


  • Amarjit Singh Vij Department of Medicine, Punjab Institute of Medical Sciences, Garha Road, Jalandhar
  • Anand N. Malaviya A&R’ Clinic for Arthritis & Rheumatism’ and Department of Rheumatology, ISIC Superspeciality Hospital, Vasant Kunj, New Delhi
  • Sharath Kumar Columbia Asia Hospital, Bangalore



Rheumatoid arthritis, Characteristics, Severity, DMARD


Background: Rheumatoid arthritis (RA) is a chronic, progressive, debilitating, systemic, autoimmune disease that mainly affects the diarthrodial joints. It is the most common form of inflammatory arthritis that occurs in approximately 1% of adults. The main objective is to study the characteristics of patients with Rheumatoid Arthritis (RA) at first presentation to a specialized rheumatology department.

Methods: The study included 122 consecutive patients with RA, fulfilling 1987 American College of Rheumatology (ACR) criteria for RA at ‘Joint Disease Clinic’ of rheumatology department, at ISIC, New Delhi.

Results: The mean age was 45.3 ± 12.4 years, F:M ratio, 8.4:1; maximum patients (31.1%) belonging to age group 30-40 years. Mean age at onset of symptoms was 38.1 ± 12.9 years and disease duration mode 5 years. 88% patients were literate and 59% referred by other patients. 14.8% patients had family history of RA, 7.38% (all males) were smokers. 16.4% female patients developed symptoms of arthritis within one year after delivery. 44.3% patients had severe, 50.8% moderate, 3.3% mild and 1.6% inactive disease (DAS 28[ESR] scoring system). 28.7% patients were taking treatment from alternative systems, 25.4% from orthopaedicians, 15.6% from internists and 8.2% from rheumatologists. Methotrexate and glucocorticoids were the most prescribed drugs (50.8% each) but in inappropriate doses. 23.8% patients had co-morbidities, hypothyroidism (9%) being the commonest.

Conclusions: RA affects middle aged women. Hypothyroidism is the mostly associated autoimmune disease. The majority receive suboptimal / inappropriate treatment before visiting a rheumatologist. Most patients consult a rheumatologist at late stage in the disease often with deformities. Hence, increased awareness is needed about this disease among patients and doctors so that patients get timely referral to a rheumatologist for the proper management of this disease.



Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376(9746):1094-108.

Shah A, Clair EW. Rheumatoid Arthritis. In Harrison’s Principles of Internal Medicine 18th ed. McGraw Hill 2012; Chapter 32: 2741.

Lee DM, Weinblatt ME: Rheumatoid arthritis. Lancet. 2001;358:903-11.

Gabriel SE, Crowson CS, Kremers HM, Doran MF, Turesson C, O’Fallon WM, et al. Survival in rheumatoid arthritis: a population-based analysis of trends over 40 years. Arthritis Rheum. 2003;48:54-8.

Mikuls TR, Saag KG, Criswell LA, Merlino LA, Kaslow RA, SheltonBJ, et al. Mortality risk associated with rheumatoid arthritis in a prospective cohort of older women: results from the Iowa Women’s Health Study. Ann Rheum Dis. 2002,61:994-9.

Pincus T, Kavanaugh A, Sokka T. Benefit/risk of therapies for rheumatoid arthritis: under estimation of the ‘side effects’ or risks of RA leads to under estimation of the benefit/risk of therapies. Clin Exp Rheumatol. 2004;22(35):S2-S11.

Malaviya AN, Kapoor SK, Singh RR, Kumar A, Pande I. Prevalence of rheumatoid arthritis in the adult Indian Population. Rheumatol Int. 1993;13(4):131-4.

Chopra A, Patil J, Billempelly V, Relwani J, Tandle HS. Prevalence of rheumatic diseases in a rural population in western India: a WHO-ILAR COPCORD study. J Assoc Physicians India. 2001;49:240-6.

van der Heijde DM, van 't Hof MA, van Riel PL, Theunisse LA, Lubberts EW, van Leeuwen MA, et al. Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Ann Rheum Dis. 1990;49:916-20.

Prevoo ML, van 't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38:44-8.

Van Gestel AM, Haagsma CJ, van Riel PL. Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum. 1998;41:1845-50.

Tembe AG, Kharbanda P, Bhojani K, Joshi VR. Profile of rheumatoid arthritis patients attending a private tertiary hospital rheumatology clinic. Indian Journal of Rheumatology. 2008;3(4):144-7.

Klareskog L, Padyukov L, Alfredsson L. Smoking as a trigger for inflammatory rheumatic diseases. Curr Opin Rheumatol. 2007;19:49-54.

Weyand CM, McCarthy TG, Goronzy JJ. Correlation between Disease Phenotype and Genetic Heterogeneity in Rheumatoid Arthritis. The Journal of Clinical Investigation. 1995;95:2120-6.

Hijmans W, Doniach D, Roitt IM, Holborow EJ. Serological overlap between lupus erythematous, rheumatoid arthritis, and thyroid auto-immune disease. Br Med J. 1961;2:909-14.

Becker KL, Ferguson RH, McConahey WM. The connective-tissue diseases and symptoms associated with Hashimoto’s thyroiditis. N Engl J Med. 1963;268:277-80.

Raterman HG, vanHalm VP, Voskuyl AE, et al. Rheumatoid arthritis is associated with a high prevalence of hypothyroidism that amplifies its cardiovascular risk. Ann Rheum Dis. 2008;67:229-32.

McCoy S, Crowson CS, Gabriel SE, Matteson EL. Hypothyroidism as a risk factor for development of cardiovascular disease in patients with rheumatoid arthritis. J Rheumatol. 2012;39:954-8.

Handa R. Tight Disease Control in Rheumatoid Arthritis – What, Why and How? In API Medicine Update, Chapter 61, 2008, vol. 18, p. 466-71.

Malaviya AN, Agarwal D, Sharma A, Gogia SB, Zaheer Q. Practising computer-aided objectified outcome-driven targeted treatment of rheumatoid arthritis in a resource constrained country: results from a single rheumatology clinic. Indian Journal of Rheumatology. 2010;5(1):3-10.




How to Cite

Vij, A. S., Malaviya, A. N., & Kumar, S. (2017). Characteristics of rheumatoid arthritis patients at first presentation to a specialized rheumatology department. International Journal of Research in Medical Sciences, 3(8), 2073–2078.



Original Research Articles