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. Myocarditis
    4. Pericardial Effusion (common)
    5. Rheumatoid Nodules in Great Vessel or Myocardium wall
      1. Causes Heart Block and Bundle Branch Block
    6. Systemic Vasculitis
    7. Cerebrovascular Disease
    8. Congestive Heart Failure
  2. Dermatologic
    1. Rheumatoid Nodules (firm, painless Subcutaneous Nodules)
    2. Rheumatoid nodulosis (cystic bone lesions)
    3. Vasculitis skin and nail changes (nail folds, leg ulcers, Urticaria)
  3. HemeOnc
    1. Normocytic normochromic Anemia
      1. Evaluate for other Anemia causes (e.g. Gastrointestinal Bleeding with Iron Deficiency Anemia)
      2. Consider Medication Causes of Macrocytic Anemia (e.g. Methotrexate-related Folate Deficiency)
      3. Consider marrow suppression or hypersplenism
    2. Mild Leukocytosis with Eosinophilia
      1. Except in Felty Syndrome (associated with Neutropenia)
    3. Thrombocytosis
    4. Immunocompromised state
      1. RA, its manifestations and treatments (e.g. Biologic Agents) increase the ris for opportunistic infections
    5. Secondary Malignancy
      1. RA is associated with an increased risk of Lymphoma
    6. Felty Syndrome
      1. Triad of RA, Splenomegaly and Neutropenia
  4. Lung
    1. Pulmonary rheumatoid Nodules
      1. Solid Nodules that are more common in men
      2. Lesions may calcify, cavitate or become secondarily infected
    2. Pleural Effusion
      1. Exudative Pleural Effusions
      2. Very low Pleural FluidGlucose and low pH
      3. More common in men, and typically small and asymptomatic
    3. Caplan Syndrome (Rheumatoid Pneumoconiosis)
      1. Peripheral, rounded, encased Pulmonary Nodules (up to 5 cm) AND
      2. Occupational Pneumoconiosis (e.g. silicosis or coal worker's lung)
    4. Interstitial Lung Disease
      1. Diffuse interstitial fibrosis associated with Dyspnea
      2. Risk of Cor Pulmonale
    5. Bronchiolitis Obliterans
      1. Organizing Pneumonia may also be present
    6. Granulomatous Pneumonitis
    7. Pulmonary arteritis
      1. Rheumatoid-related Vasculitis with risk of Pulmonary Infarction
    8. Rheumatoid Arthritis medications effecting lung disease
      1. Methotrexate-Induced Pulmonary fibrosis
      2. Opportunistic infections in patients on Biologic Agents (e.g. Tuberculosis)
  5. Ophthalmologic manifestations
    1. Keratoconjunctivitis Sicca or Sjogren's Syndrome (common)
    2. Peripheral Ulcerative Keratitis
    3. Episcleritis or Scleritis
      1. Risk of Scleromalacia perforans (orbit rupture)
    4. Brown's Syndrome
      1. Superior Oblique MuscleTendinitis results in Diplopia
  6. Neurologic manifestations
    1. Peripheral Neuropathy (e.g. Carpal Tunnel)
      1. Rheumatoid Granulomata near nerve roots result in Entrapment Neuropathy
    2. Mononeuritis multiplex
      1. Secondary to Vasculitis
    3. Transverse Myelitis
    4. C-Spine involvement Overall (up to 80% of patients)
    5. C-Spine Atlantoaxial Subluxation
      1. Cervical Spine subluxation at C1-2 (up to 25 to 40% of patients)
      2. Risk of secondary Cervical Myelopathy from central spinal stenosis
      3. Results from Rheumatoid Arthritis erosions and inflammation
        1. Affects odontoid process, transverse ligament, alar ligament, C1 lateral mass
      4. References
        1. Shlobin (2021) Neurosurg Rev 44(4): 1957-65 [PubMed]
  7. Miscellaneous
    1. Renal Disease
      1. RA is associated with Glomerulonephritis (e.g. Vasculitis, Amyloidosis)
      2. Evaluate for Nephrotoxic Drugs
    2. Liver Dysfunction
      1. Associated with Hepatic Fibrosis, Hepatosplenomegaly, increased Liver Function Tests
    3. Hoarseness (extreme and progressive)
      1. Rheumatoid changes in laryngeal cricoarytenoid joints

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Ontology: Rheumatoid Arthritis (C0003873)

Definition (MEDLINEPLUS)

Rheumatoid arthritis (RA) is a form of arthritis that causes pain, swelling, stiffness and loss of function in your joints. It can affect any joint but is common in the wrist and fingers.

More women than men get rheumatoid arthritis. It often starts in middle age and is most common in older people. But children and young adults can also get it. You might have the disease for only a short time, or symptoms might come and go. The severe form can last a lifetime.

Rheumatoid arthritis is different from osteoarthritis, the common arthritis that often comes with older age. RA can affect body parts besides joints, such as your eyes, mouth and lungs. RA is an autoimmune disease, which means the arthritis results from your immune system attacking your body's own tissues.

No one knows what causes rheumatoid arthritis. Genes, environment and hormones might contribute. Treatments include medicine, lifestyle changes and surgery. These can slow or stop joint damage and reduce pain and swelling.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Definition (NCI_NCI-GLOSS) An autoimmune disease that causes pain, swelling, and stiffness in the joints, and may cause severe joint damage, loss of function, and disability. The disease may last from months to a lifetime, and symptoms may improve and worsen over time.
Definition (NCI) A chronic systemic disease, primarily of the joints, marked by inflammatory changes in the synovial membranes and articular structures, widespread fibrinoid degeneration of the collagen fibers in mesenchymal tissues, and by atrophy and rarefaction of bony structures. Etiology is unknown, but autoimmune mechanisms have been implicated.
Definition (MSH) A chronic systemic disease, primarily of the joints, marked by inflammatory changes in the synovial membranes and articular structures, widespread fibrinoid degeneration of the collagen fibers in mesenchymal tissues, and by atrophy and rarefaction of bony structures. Etiology is unknown, but autoimmune mechanisms have been implicated.
Definition (CSP) chronic systemic disease, primarily of the joints, marked by inflammatory changes in the synovial membranes and articular structures, widespread fibrinoid degeneration of the collagen fibers in mesenchymal tissues, and by atrophy and rarefaction of bony structures; etiology is unknown, but autoimmune mechanisms have been implicated.
Concepts Disease or Syndrome (T047)
MSH D001172
ICD9 714.0
ICD10 M06.9 , M06.99
SnomedCT 156471009, 287010008, 156481008, 69896004
LNC LP30644-6, LA15161-5
English Arthritis, Rheumatoid, ARTHRITIS RHEUMATOID, Rheumatoid Arthritis, Rheumatoid arthritis, unspecified, RHEUMATOID ARTHRITIS, RHEUMATOID ARTHRITIS, SUSCEPTIBILITY TO, Rheumatoid arthritis NOS, rheumatoid arthritis, RA (rheumatoid arthritis), rheumatoid arthritis (diagnosis), R arthritis, Rh arthritis, Arthritis rheumatoid, Systemic rheumatoid arthritis, RA, Arthritis, Rheumatoid [Disease/Finding], Rheumatoid arthritis, unspecified, site unspecified, rheumatoid arthritis systemic, gout rheumatic, proliferative arthritis, atrophic arthritis, Rheumatoid arthritis NOS (disorder), ARTHRITIS, RHEUMATOID, Rheumatoid arthritis, Atrophic arthritis, Chronic rheumatic arthritis, Rheumatic gout, RA - Rheumatoid arthritis, RhA - Rheumatoid arthritis, Rheumatoid disease, Rheumatoid arthritis (disorder), atrophic; arthritis, rheumatoid; arthritis, arthritis; atrophic, arthritis; rheumatoid, Atrophic Arthritis, Arthritis or polyarthritis, atrophic, Arthritis or polyarthritis, rheumatic
Portuguese ARTRITE REUMATOIDE, Artrite reactiva reumatóide, Artrite atrófica, Artrite reumatóide sistémica, Artrite Reumatoide, Artrite reumatóide
Spanish ARTRITIS REUMATOIDE, Artritis reumatoide sistémica, Artritis R, Artritis Re, Artritis atrófica, AR, Artritis Reumatoidea, artritis reumatoide, SAI, Rheumatoid arthritis NOS, artritis reumatoide, SAI (trastorno), artritis atrófica, artritis reumatoide (trastorno), artritis reumatoide, artritis reumática crónica, gota reumática, Artritis reumatoide, Artritis Reumatoide
Dutch systemische reumatoïde artritis, atrofische artritis, RA, reumatische artritis, artritis; atrofisch, artritis; reumatoïd, atrofisch; artritis, reumatoïd; artritis, Reumatoïde artritis, niet gespecificeerd, reumatoïde artritis, Artritis, reumatoïde, Reumatoïde artritis
French Arthrite d, Arthrite rhumatoïde systémique, AR, Polyarthrite rh, ARTHRITE RHUMATOIDE, Polyarthrite rhumatismale, PCE (Polyarthrite Chronique Évolutive), Polyarthrite chronique évolutive, Polyarthrite rhumatoïde, PR (Polyarthrite Rhumatoïde)
German systemische rheumatische Arthritis, atrophische Arthritis, Rh Arthritis, RA, R Arthritis, ARTHRITIS RHEUMATOID, Chronische Polyarthritis, nicht naeher bezeichnet, rheumatoide Arthritis, Arthritis, rheumatoide, Rheumatoide Arthritis, PcP (Primär-chronische Polyarthritis), Polyarthritis, primär chronische, Primär-chronische Polyarthritis
Italian Artrite reumatoide sistemica, AR, Artrite atrofica, Artrite reumatoide
Japanese 全身性関節リウマチ, イシュクセイカンセツエン, ゼンシンセイカンセツリウマチ, カンセツリウマチ, 関節リウマチ, 萎縮性関節炎, リウマチ様関節炎, 慢性関節リウマチ, 関節リウマチ-慢性, 関節炎-リウマチ様
Swedish Ledgångsreumatism
Czech polyartritida progresivní, Systémová revmatoidní artritida, Revmatoidní artritida, Atrofická artritida, artritida revmatoidní, revmatoidní artritida
Finnish Nivelreuma
Russian ARTRIT REVMATOIDNYI, ARTRIT INFEKTSIONNYI NESPETSIFICHESKII, POLIARTRIT REVMATOIDNYI, АРТРИТ ИНФЕКЦИОННЫЙ НЕСПЕЦИФИЧЕСКИЙ, АРТРИТ РЕВМАТОИДНЫЙ, ПОЛИАРТРИТ РЕВМАТОИДНЫЙ
Korean 상세불명의 류마티스 관절염
Croatian ARTRITIS, REUMATOIDNI
Polish Zapalenie stawów reumatoidalne, Gościec przewlekły postępujący, RZS, Reumatoidalne zapalenie stawów, Gościec pierwotnie przewlekły, Zapalenie gośćcowe
Hungarian RA (rheumatoid arthritis), Rheumatoid arthritis, Atrophiás arthritis, R arthritis, Rh arthritis, Systemás rheumatoid arthritis
Norwegian Artritt, revmatoid, Leddgikt, Revmatoid artritt