With Rheumatoid Arthritis, Thinking Outside the Box Means Looking Beyond The Joints

Mark Borigini, M.D. Health Pro
  • It is so easy to forget that arthritis is not the only problem we see with rheumatoid arthritis, particularly when the disease is labeled and named an ARTHRITIS. However, the so-called extra-articular manifestations of rheumatoid arthritis can cause significant disability, even death.


    It must not be forgotten that rheumatoid arthritis is a SYSTEMIC disease, the most basic manifestation being malaise and fatigue. But there can also be significant inflammation of a variety of organ systems, particularly in those patients who are rheumatoid factor positive. Such patients also, in general, suffer from more severe arthritis and often have nodules.

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    Rheumatoid nodules develop in about 50% of people suffering from rheumatoid arthritis, and most of these patients are rheumatoid factor positive. Another extra-articular manifestation of rheumatoid arthritis involving the skin is vasculitis.


    Sjogren's syndrome can cause dry mouth and dry eyes, common in rheumatoid arthritis. Episcleritis is also common. Unfortunately, scleritis has a more damaging course, and can erode the affected part of the eye.


    Many rheumatoid arthritis patients suffer from interstitial lung disease. But because patients are not that physically active due to their joint disease, they do not experience shortness of breath. Patients may also develop rheumatoid nodules in the lung tissue. Pleurisy, or inflammation of the lining of the lungs, may occur. Interestingly, methotrexate, a drug commonly used in rheumatoid arthritis, may itself cause interstitial lung disease, so it is best for patients to have a chest x-ray performed as a baseline before they are started on methotrexate.


    Just as the lining of the lungs can be inflamed, that of the heart can also be inflamed, a condition called pericarditis. Rarely, there can be heart rhythm problems, heart valve malfunction and inflammation of the blood vessels, including the aorta.


    There might be inflammation of the blood vessels supplying the intestines, resulting in abdominal pain.


    Kidney disease is rarely seen in rheumatoid arthritis, but it can occur.


    Neurologic damage can occur due to inflammation of the blood vessels supplying the nerves. It can also occur due instability of the cervical spine.


    Blood changes can be seen also. Felty's syndrome has classically been described as rheumatoid arthritis, enlarged spleen, low white blood cell count, and leg ulcers. This is seen most commonly in patients with severe, nodule-forming rheumatoid arthritis.


    Treatment of the non-joint manifestations of rheumatoid arthritis involves the same medications used to treat the arthritis.


    Patients should not hesitate to let their doctors know if they have any other complaints outside the joints; it could be serious AND treatable.

Published On: January 11, 2008