The temporal relationship of Raynaud's phenomenon and features of connective tissue disease in rheumatoid arthritis.

OBJECTIVE

In a prospective cohort study we examined the relationship between Raynaud's phenomenon (RP) onset and other connective tissue disease (CTD) characteristics in rheumatoid arthritis (RA) to determine if RP is predictive of RA severity and associated with other CTD signs, and if late onset RP in RA has an effect on prognosis compared to other patients with RA.

METHODS

Using a standardized assessment, data were collected on 328 subjects with RA [mean age 60.3 +/- 0.7; 77% women; 76% erosions, 75% positive rheumatoid factor (RF)] seen at one London, Ontario, rheumatology clinic. The data included RA disease duration; presence and duration of RP; presence of nodules, joint damage, telangiectasia, and sclerodactyly; and RF status (+/-), RF value, antinuclear antibodies, and E-nuclear antibodies.

RESULTS

The mean RA disease duration was 12 +/- 0.6 years. Seventy-one (22%) had RP and the mean RP duration was 9.2 +/- 1.5 years. Patients presented with RP a mean of 3.8 +/- 1.4 years after the diagnosis of RA. RP status was positively associated with the presence of sclerodactyly (p < 0.001), but not nodules or erosions. Higher RF values were associated with longer RA disease duration (p < 0.002) and longer RP duration (p < 0.01).

CONCLUSION

Idiopathic RP may have a different clinical effect on RA than secondary RP; the latter is correlated with more severe RA. Sclerodactyly is associated with erosive arthritis and RP in RA. Higher RF values were indicative of increased RA and RP duration.