Extra-articular features of rheumatoid arthritis

Extra-articular features of RA that are commonly seen in routine practice include:

  • nonspecific systemic upset (eg malaise, fatigue, weight loss, anaemia of chronic disease, fever)
  • keratoconjunctivitis sicca (secondary Sjögren syndrome1)
  • rheumatoid nodules—often found in the skin, sometimes in the lungs or other organs
  • interstitial lung changes (eg asymptomatic interstitial lung changes [very common], interstitial lung disease, pulmonary nodules, pleural effusion)
  • ocular involvement (eg episcleritis, scleritis).

All other extra-articular features of RA are much less commonly seen in routine practice. These may include:

  • antiphospholipid syndrome
  • cardiac disease (eg pericarditis, myocarditis)
  • Felty syndrome—RA associated with hypersplenism and neutropenia
  • kidney disease (eg glomerulonephritis)
  • neurological disease (eg mononeuritis multiplex secondary to vasculitis)
  • vasculitic rash.
1 Secondary Sjögren syndrome involves dry eyes, mouth and other mucous membranes in association with other inflammatory diseases (eg RA or systemic lupus erythematosus). Primary Sjögren syndrome is a separate disease with similar clinical features (eg dry mucous membranes) and a characteristic serological profile, often including a positive rheumatoid factor.Return