Rheumatoid Arthritis in Greek and British Patients. A Comparative Clinical, Radiologic, and Serologic Study

Objective: To compare the clinical, radiologic, and serologic expression of rheumatoid arthritis (RA) in 2 different populations.

Methods: Standard protocols and assessment criteria were used in this study of 108 Greek and 107 British patients with RA.

Results: British patients had more severe articular involvement than did Greeks, as judged by the duration of morning stiffness (P less than 0.005), grip strength (P less than 0.0001), and the numbers of swollen (P less than 0.001) and tender (P less than 0.0001) joints. The British RA patients also had more severe joint damage on radiologic examination, as evidenced by Steinbrocker stage III (P less than 0.005) and IV (P less than 0.025) disease and had more extraarticular manifestations (P less than 0.0001), including rheumatoid nodules (P less than 0.0001) and Raynaud's phenomenon (P less than 0.05). Greek RA patients, however, more frequently presented with sicca manifestations (P less than 0.001) and serum antibodies to Ro/SS-A (P less than 0.025). Furthermore, Ro/SS-A antibodies were associated with a high incidence of side effects to D-penicillamine only in the Greeks.

Conclusion: Genetic and environmental factors may be responsible for these striking differences in disease expression between these 2 European populations with RA.