Extra-articular Manifestations of RA: A Quiz

ANSWER: Research suggests that the risk of cardiovascular disease (CVD) is about two times higher in patients with rheumatoid arthritis (RA) compared with the general population. While individuals with RA may share many of the traditional risk factors for CVD (insulin resistance, smoking, dyslipidemia, hypertension), the systemic inflammation related to their RA may also contribute to additional CV risk. Increased CV risk is found in early RA and further increases over time.

Source
Cutolo M, Kitas GD, van Riel PL, et al. Burden of disease in treated rheumatoid arthritis patients: going beyond the joint. Semin Arthritis Rheum. 2014;43:479-488. doi: 10.1016/j.semarthrit.2013.08.004.

ANSWER: Patients with RA are at increased risk for certain types of malignancy, especially lymphoma, skin cancer, and lung cancer. However, evidence suggests that the risk of colorectal and breast cancer may actually be decreased with RA.¹ On the other hand, individuals with RA are at increased risk for respiratory disease (including interstitial lung disease), osteoporosis, infection, cardiac manifestations (such as pericarditis), and cardiovascular disease. Some of this increased risk is related to medications used to treat RA, although disease activity and systemic inflammation in RA may also be involved.²

Sources1. Simon TA, Thompson A, Gandhi KK, et al. Incidence of malignancy in adult patients with rheumatoid arthritis: a meta-analysis. Arthritis Res Ther. 2015;17:212. doi: 10.1186/s13075-015-0728-9.

2. Cutolo M, Kitas GD, van Riel PL, et al. Burden of disease in treated rheumatoid arthritis patients: going beyond the joint. Semin Arthritis Rheum. 2014;43:479-488. doi: 10.1016/j.semarthrit.2013.08.004.

ANSWER: Keratoconjunctivitis sicca (“dry eye”) is the most common ocular manifestation in RA and may affect up to 10% of patients, according to some studies. The condition often manifests as secondary Sjogren syndrome and co-occurs with xerostomia. While episcleritis, scleritis, and peripheral ulcerative keratitis can occur in RA, they are less common than keratoconjunctivitis sicca.

Source
Cojocaru M, Cojocaru IM, Silosi I, et al. Extra-articular manifestations in rheumatoid arthritis. Maedica (Buchar). 2010;5:286-291.

ANSWER: Rheumatoid nodules are the most common skin manifestation in RA and may affect up to 20% of patients. Rheumatoid nodules are predominantly found in rheumatoid factor–positive individuals and usually occur on extensor surfaces such as the upper arm and elbow. Nodules are thought to develop because of small vessel vasculitis. Rheumatoid nodules can also occur in the lungs and heart.

Source
Cojocaru M, Cojocaru IM, Silosi I, et al. Extra-articular manifestations in rheumatoid arthritis. Maedica (Buchar). 2010;5:286-291.

ANSWER: Many of the extra-articular manifestations of RA are caused by rheumatoid vasculitis. These include rheumatoid nodules, skin ulcerations, scleritis, neurological problems (sensorimotor neuropathy or neuritis), pericarditis, and pleuritis.¹ Rarely, vessels in the brain, heart, and abdomen can be affected and increase the risk of stroke, myocardial infarction, and intestinal infarction.²

Sources1. Cojocaru M, Cojocaru IM, Silosi I, et al. Extra-articular manifestations in rheumatoid arthritis. Maedica (Buchar). 2010;5:286-291.

2. Vasculitis Foundation. Rheumatoid vasculitis. Accessed May 22, 2018.