From the Journals

Extra-articular RA manifestations are in decline, but mortality is still a problem



The incidence of extra-articular manifestations of rheumatoid arthritis (ExRA) has declined over time, but the manifestations’ association with increased mortality risk has not changed.


  • A retrospective, population-based cohort study that included 907 adults with incident RA diagnosed during 1985-1999 (n = 296) or 2000-2014 (n = 611) in Olmsted County, Minn.
  • Researchers assessed the cumulative incidence of ExRA in groups from both time periods.
  • Cox proportional hazard models were used to identify associations between mortality and ExRA.


  • Patients with ExRA had double the risk for premature mortality compared with those without ExRA (hazard ratio, 2.0), with increased mortality for both severe and nonsevere cases of ExRA (HR, 3.05 and 1.83, respectively).
  • The 10-year cumulative incidence of developing any ExRA decreased significantly between the 1985-1999 group and the 2000-2014 group (45.1% vs. 31.6%; P = .001).
  • The incidence of subcutaneous rheumatoid nodules decreased significantly between the two time periods (30.9% vs. 15.8%, respectively; P < .001), as did the incidence of nonsevere ExRA (41.4% vs. 28.8%, respectively; P < .001).
  • Rheumatoid nodules were associated with increased mortality risk, and rheumatoid factor positivity was the strongest risk factor for developing ExRA and rheumatoid nodules.


The results illustrate the need to recognize the increased mortality risk for patients with severe or nonsevere ExRA.


First author Bradly A. Kimbrough, MD, and colleagues at the Mayo Clinic, Rochester, Minn., published their report online in Arthritis Care & Research.


The single geographic region and demographics of the study limit its generalizability, and its interpretation is affected by a lack of data on disease activity and the impact of improved therapeutics and management strategies.


The study was supported by grants from the National Institute of Arthritis and Musculoskeletal and SkinDiseases, the National Institute on Aging, and the National Center for Advancing Translational Sciences. Dr. Kimbrough had no financial conflicts to disclose. Two coauthors reported financial relationships with one or more pharmaceutical companies.

A version of this article first appeared on

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