II. Epidemiology

  1. Extra-articular findings in 20-40% of Rheumatoid Arthritis patients

III. Risk Factors: Extra-articular RA findings

  1. Male Gender
  2. Seropositive (RF, ACPA, ANA)
  3. Tobacco Abuse

IV. Findings: Common Extra-Articular

  1. Rheumatoid Nodules
  2. Profound Fatigue
  3. Low-grade fever
  4. Weight loss
  5. Normochromic Normocytic Anemia

V. Findings: Other Extra-Articular

  1. Cardiovascular
    1. Accelerated Coronary Artery Disease (leading cause of death in RA)
    2. Pericarditis
    3. Pericardial Effusion
    4. Rheumatoid Nodules in Great Vessel or Myocardium wall
      1. Causes Heart Block and Bundle Branch Block
    5. Systemic Vasculitis
  2. Lung
    1. Pulmonary Nodules
    2. Pleural Effusion (very low Pleural FluidGlucose)
    3. Caplan Syndrome (Lung Nodules, pneumoconiosis)
    4. Interstitial Lung Disease
  3. Ophthalmologic manifestations
    1. Keratoconjunctivitis Sicca (common)
    2. Episcleritis or Scleritis
    3. Peripheral Ulcerative Keratitis
    4. Scleromalacia
  4. Neurologic manifestations
    1. Rheumatoid Granulomata near nerve roots
    2. Neuropathy (e.g. Carpal Tunnel, mononeuritis multiplex)
    3. Cervical Spine involvement (up to 80% of patients)
    4. Cervical Spine subluxation at C1-2 (up to 25 to 40% of patients)
      1. Risk of secondary Cervical Myelopathy from central spinal stenosis
      2. Results from Rheumatoid Arthritis erosions and inflammation
        1. Affects odontoid process, transverse ligament, alar ligament, C1 lateral mass
      3. References
        1. Shlobin (2021) Neurosurg Rev 44(4): 1957-65 [PubMed]
  5. Hoarseness (extreme and progressive)
    1. Rheumatoid changes in laryngeal cricoarytenoid joints
  6. Felty Syndrome

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