Rheumatoid arthritis in greek and british patients. a comparative clinical, radiologic, and serologic study

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Abstract
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 < 0.005), grip strength (P < 0.0001), and the numbers of swollen (P < 0.001) and tender (P < 0.0001) joints. The British RA patients also had more severe joint damage on radiologic examination, as evidenced by Steinbrocker stage III (P < 0.005) and IV (P < 0.025) disease and had more extraarticular manifestations (P < 0.0001), including rheumatoid nodules (P < 0.0001) and Raynaud's phenomenon (P < 0.05). Greek RA patients, however, more frequently presented with sicca manifestations (P < 0.001) and serum antibodies to Ro/SS‐A (P < 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.