To assess changes in the cumulative incidence of extraarticular manifestations of rheumatoid arthritis (ExRA) and associated mortality risk.
This study evaluated trends in occurrence of ExRA using a population-based inception cohort that included all adult patients with incident RA from 1985 through 2014 meeting the 1987 American College of Rheumatology criteria. Patients were divided into two cohorts based on the incidence date of RA, 1985-1999 and 2000-2014. The occurrence of ExRA was determined by manual chart review, and the 10-year cumulative incidence was estimated for each ExRA in both cohorts. Cox proportional hazard models were used to determine associations between specific demographic and RA disease characteristics and ExRA and between ExRA and mortality.
There were 907 patients included, 296 in the 1985-1999 cohort and 611 in the 2000-2014 cohort. The 10-year cumulative incidence of any ExRA decreased significantly between the earlier and later cohorts (45.1% vs 31.6%, p<0.001). This was largely driven by significant declines in subcutaneous rheumatoid nodules (30.9% vs 15.8%, p<0.001) and non-severe ExRA (41.4% vs 28.8%, p=0.001). Identified risk factors for the development of any ExRA include RF positivity (hazard ratio [HR] 2.02, 95% confidence interval [CI] 1.43-2.86) and current smoking (HR 1.61, 95% CI 1.10-2.34). Mortality was increased in patients with either non-severe (HR 1.83, 95% CI 1.18-2.85) or severe ExRA (HR 3.05, 95% CI 1.44-6.49).
The incidence of ExRA have decreased over time. Mortality remains increased in patients with ExRA. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.