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Delayed referral, socioeconomic status, and disease characteristics as factors associated with disabilities in rheumatoid arthritis patients: a multicenter observational study
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 25 June 2026
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Objective. This study aims to identify factors associated with higher Rheumatoid Arthritis Articular Damage (RAAD) scores in rheumatoid arthritis (RA) patients and to evaluate correlations between disease duration, joint involvement, extra-articular manifestations, and functional outcomes with the severity of articular damage.
Methods. This multicenter, cross-sectional study was conducted across 8 tertiary care centers in India using the Indian Rheumatology Association database (2019-2022). Patients fulfilling the 2010 ACR/EULAR RA criteria were included. Demographic, clinical, socioeconomic, comorbidity, and disease-specific variables were collected. Articular damage was assessed using the RAAD score. Logistic regression was performed to identify predictors of damage.
Results. Of 4641 recruited patients, 4213 were analyzed (mean age 52.8 years; 87.6% female). Severe damage was observed in 9%, moderate in 9.2%, and absent in 81.9%. Patients with severe damage had longer disease duration (median 13 vs. 8 years; p<0.001), more frequent extra-articular (10.3%) and systemic features (7.9%), and greater functional disability (mean health assessment questionnaire 11.12 vs. 3.96; p<0.001). Logistic regression identified longer disease duration [odds ratio (OR) 1.008, p<0.001], higher visual analog scale pain (OR 1.054, p=0.009), physician (OR 1.134, p=0.004) and patient global assessments (OR 1.224, p<0.001), extra-articular features (OR 2.885, p<0.001), and systemic features (OR 4.935, p<0.001) as independent predictors of joint damage.
Conclusions. Severe joint damage is associated with delayed presentation, higher disease activity, and extra-articular/systemic features. Socioeconomic factors and comorbidities also influence outcomes. Early referral and comprehensive management are essential to reduce long-term disability in RA.
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Ethics Approval
All the participating centers have received ethics committee approval. The approval letter numbers are provided. ChanRe Rheumatology and Immunology Center and Research - IEC-CRICR-132/101/2020 (5/10/2020); Sree Sudheendra Medical Mission (12/09/2020); All India Institute of Medical Sciences - IEC-59/03.07.2020.RP- 462020 (15/07/2020); Ethics Committee of Care Institute of Medical Sciences (25/07/2024); Institute of Postgraduate Medical Education and Research - IPGME&RC/IEC/2020/478 (16/06/2020); The International Ethics Committee of LN Medical College and JK Hospital - LNMC&RC/Dean/2020/Ethics/146 (7/08/2020); S2J Independent Ethics Committee (20/07/2021).How to Cite
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Delayed referral, socioeconomic status, and disease characteristics as factors associated with disabilities in rheumatoid arthritis patients: a multicenter observational study. Reumatismo [Internet]. 2026 Jun. 25 [cited 2026 Jun. 25];. Available from: https://www.reumatismo.org/reuma/article/view/1852
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