Prevalence and Clinical Predictors of Early Rheumatoid Arthritis in Pakistani Adults Attending Tertiary Care Hospitals
DOI:
https://doi.org/10.53350/Annalspakmed.1.9.14Keywords:
Early rheumatoid arthritis, anti-CCP antibodies, ESR, clinical predictors, Pakistan, inflammatory arthritis.Abstract
Background: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease, and in its early stages of development, it is characterized by insidious clinical manifestations, so it is difficult to diagnose it in a low-resource environment. In order to avoid long-term joint damage, it is important to start disease-modifying therapy as early as possible. Very little information is available concerning the burden and clinical predictors of early RA among Pakistani adults visiting tertiary hospitals.
Objectives: To ascertain how early RA is found in adults who present with recent onset joint symptoms in tertiary care hospitals in Punjab, Pakistan, and to ascertain clinical and laboratory predictors of early RA.
Methods: The study was a cross-sectional study organized in tertiary care hospitals in Punjab between June 2024 and May 2025. They recruited seventy adults who had joint symptoms of less than 12 months. The 2010 ACR/EULAR criteria were applied in the diagnosis of early RA. Demographics, clinical and laboratory parameters such as rheumatoid factor, anti-cyclic citrullinated peptide (anti-CCP) antibodies, ESR and CRP were noted. The chi-square tests and multivariate logistic regression were applied to analyze associations.
Results: Early RA prevalence was 40% (28/70). The disease was both sexually transmitted and there was a better representation of females. The early RA was highly related to morning stiffness of 60 minutes and more, symmetrical small-joint swelling, and hand and wrist involvement. The highest predictive value appeared to be anti-CCP, then, high ESR. RF and CRP were supportive markers, which were less predictive in adjusted analysis.
Conclusion: Symptomatic adults who access tertiary care centers in Punjab have prevalence of early RA. The most important predictors are anti-CCP positivity, long-lasting morning stiffness, symmetrical swelling of joints, and increased ESR. These markers should be incorporated into early assessment protocols and can enhance earlier diagnosis and clinical outcomes.
References
1. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2019;393:2205-2219. doi:10.1016/S0140-6736(19)30092-5.
2. Sparks JA. Rheumatoid arthritis epidemiology in the era of biologics. Nat Rev Rheumatol. 2019;15:408-420. doi:10.1038/s41584-019-0221-6.
3. Lübke N, Burmester GR, Buttgereit F. Early arthritis and the importance of early intervention. RMD Open. 2020;6:e001183. doi:10.1136/rmdopen-2020-001183.
4. van der Helm-van Mil AHM, Boeters DM, Ten Brinck RM, et al. Identifying RA in early arthritis clinics. Arthritis Res Ther. 2020;22:267. doi:10.1186/s13075-020-02361-9.
5. Aletaha D, Alasti F, Smolen JS. Diagnosis of early RA in clinical practice. Rheumatology (Oxford). 2020;59:3693-3701. doi:10.1093/rheumatology/keaa155.
6. O’Neil LJ, Kapoor SR, Conaghan PG, et al. Predictors of persistent inflammatory arthritis. Semin Arthritis Rheum. 2021;51:1-8. doi:10.1016/j.semarthrit.2020.12.012.
7. Bugatti S, Manzo A, Vitolo B, et al. B-cell activation predicts RA progression. Ann Rheum Dis. 2021;80:667-675. doi:10.1136/annrheumdis-2020-218538.
8. van Dijk T, Gerlag DM, Tak PP. The pre-RA phase and early disease mechanisms. Nat Rev Rheumatol. 2021;17:717-728. doi:10.1038/s41584-021-00716-5.
9. Ytterberg SR, Bhatt DL, Mikuls TR, et al. Cardiovascular risk in RA patients. N Engl J Med. 2022;386:2068-2078. doi:10.1056/NEJMoa2114663.
10. Henes J, Müller-Ladner U, Albrecht K, et al. Anti-CCP antibodies in early arthritis diagnosis. Arthritis Care Res. 2022;74:233-241. doi:10.1002/acr.24658.
11. Wang Z, Chen X, Li W, et al. Role of ESR and CRP in RA disease prediction. Clin Rheumatol. 2022;41:3023-3031. doi:10.1007/s10067-021-06037-w.
12. Zeng X, Deng Y, Yang Z, et al. Clinical characteristics of early-onset RA. Mod Rheumatol. 2022;32:563-572. doi:10.1080/14397595.2021.1906578.
13. Misra DP, Agarwal V, Gasparyan AY, et al. Rheumatoid arthritis in South Asia: epidemiology and clinical patterns. Clin Rheumatol. 2023;42:1105-1116. doi:10.1007/s10067-022-06469-0.
14. Khan W, Haider Z, Baig M, et al. Seropositivity patterns of RA in Pakistani adults. J Pak Med Assoc. 2023;73:510-516. doi:10.47391/JPMA.6631.
15. Ahmed H, Riaz Z, Sohail M, et al. Predictors of inflammatory arthritis in early disease clinics. BMC Rheumatol. 2023;7:28. doi:10.1186/s41927-023-00346-0.
16. Boeters DM, Nieuwenhuis WP, Reijnierse M, et al. Small-joint inflammation as an early RA marker. Arthritis Res Ther. 2023;25:59. doi:10.1186/s13075-023-03041-6.
17. Chen J, Li Y, Lin S, et al. Clinical predictors of RA progression in early inflammatory arthritis. Int J Rheum Dis. 2024;27:210-219. doi:10.1111/1756-185X.14758.
18. Selmi C, Generali E, Massarotti M, et al. Advances in early RA pathogenesis and diagnosis. Autoimmun Rev. 2024;23:103-114. doi:10.1016/j.autrev.2023.103176.
19. Farooqi A, Sohail S, Malik S, et al. Early RA diagnostic patterns in Pakistani tertiary hospitals. Pak J Med Sci. 2024;40:120-128. doi:10.12669/pjms.40.1.8723.
20. Skaria TG, Narayanan S, Manoj M, et al. Utility of anti-CCP in early inflammatory arthritis. Rheumatol Int. 2025;45:55-64. doi:10.1007/s00296-024-05589-3.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 JAHANZAIB MALIK, SALEH RASHEED, FAISAL TOHEED
This work is licensed under a Creative Commons Attribution 4.0 International License.
