II. Epidemiology
- Extra-articular findings in 20-40% of Rheumatoid Arthritis patients
III. Risk Factors: Extra-articular RA findings
- Male Gender
- Seropositive (RF, ACPA, ANA)
- Tobacco Abuse
IV. Findings: Common Extra-Articular
- Rheumatoid Nodules
- Profound Fatigue
- Low-grade fever
- Weight loss
- Normochromic Normocytic Anemia
V. Findings: Other Extra-Articular
- Cardiovascular
- Accelerated Coronary Artery Disease (leading cause of death in RA)
- Pericarditis
- Myocarditis
- Pericardial Effusion (common)
- Rheumatoid Nodules in Great Vessel or Myocardium wall
- Causes Heart Block and Bundle Branch Block
- Systemic Vasculitis
- Cerebrovascular Disease
- Congestive Heart Failure
- Dermatologic
- Rheumatoid Nodules (firm, painless Subcutaneous Nodules)
- Rheumatoid nodulosis (cystic bone lesions)
- Vasculitis skin and nail changes (nail folds, leg ulcers, Urticaria)
-
HemeOnc
- Normocytic normochromic Anemia
- Evaluate for other Anemia causes (e.g. Gastrointestinal Bleeding with Iron Deficiency Anemia)
- Consider Medication Causes of Macrocytic Anemia (e.g. Methotrexate-related Folate Deficiency)
- Consider marrow suppression or hypersplenism
- Mild Leukocytosis with Eosinophilia
- Except in Felty Syndrome (associated with Neutropenia)
- Thrombocytosis
- Immunocompromised state
- RA, its manifestations and treatments (e.g. Biologic Agents) increase the ris for opportunistic infections
- Secondary Malignancy
- RA is associated with an increased risk of Lymphoma
- Felty Syndrome
- Triad of RA, Splenomegaly and Neutropenia
- Normocytic normochromic Anemia
-
Lung
- Pulmonary rheumatoid Nodules
- Solid Nodules that are more common in men
- Lesions may calcify, cavitate or become secondarily infected
-
Pleural Effusion
- Exudative Pleural Effusions
- Very low Pleural FluidGlucose and low pH
- More common in men, and typically small and asymptomatic
- Caplan Syndrome (Rheumatoid Pneumoconiosis)
- Peripheral, rounded, encased Pulmonary Nodules (up to 5 cm) AND
- Occupational Pneumoconiosis (e.g. silicosis or coal worker's lung)
-
Interstitial Lung Disease
- Diffuse interstitial fibrosis associated with Dyspnea
- Risk of Cor Pulmonale
-
Bronchiolitis Obliterans
- Organizing Pneumonia may also be present
- Granulomatous Pneumonitis
- Pulmonary arteritis
- Rheumatoid-related Vasculitis with risk of Pulmonary Infarction
-
Rheumatoid Arthritis medications effecting lung disease
- Methotrexate-Induced Pulmonary fibrosis
- Opportunistic infections in patients on Biologic Agents (e.g. Tuberculosis)
- Pulmonary rheumatoid Nodules
- Ophthalmologic manifestations
- Keratoconjunctivitis Sicca or Sjogren's Syndrome (common)
- Peripheral Ulcerative Keratitis
- Episcleritis or Scleritis
- Risk of Scleromalacia perforans (orbit rupture)
- Brown's Syndrome
- Superior Oblique MuscleTendinitis results in Diplopia
- Neurologic manifestations
- Peripheral Neuropathy (e.g. Carpal Tunnel)
- Rheumatoid Granulomata near nerve roots result in Entrapment Neuropathy
- Mononeuritis multiplex
- Secondary to Vasculitis
- Transverse Myelitis
- C-Spine involvement Overall (up to 80% of patients)
- C-Spine Atlantoaxial Subluxation
- Cervical Spine subluxation at C1-2 (up to 25 to 40% of patients)
- Risk of secondary Cervical Myelopathy from central spinal stenosis
- Results from Rheumatoid Arthritis erosions and inflammation
- Affects odontoid process, transverse ligament, alar ligament, C1 lateral mass
- References
- Peripheral Neuropathy (e.g. Carpal Tunnel)
- Miscellaneous
- Renal Disease
- RA is associated with Glomerulonephritis (e.g. Vasculitis, Amyloidosis)
- Evaluate for Nephrotoxic Drugs
- Liver Dysfunction
- Associated with Hepatic Fibrosis, Hepatosplenomegaly, increased Liver Function Tests
- Hoarseness (extreme and progressive)
- Rheumatoid changes in laryngeal cricoarytenoid joints
- Renal Disease