Extra-Articular or Systemic Manifestations of Rheumatoid Arthritis
You know that rheumatoid arthritis (RA) affect the joints. It’s the obvious part of the disease, reflecting the arthritis in the name. But did you know that RA also affects other parts of your body? These are called the extra-articular manifestations of RA.
Extra-articular means outside of or other than a joint. RA affects your joints, as well as other systems in your body. Therefore, you can also call these manifestations or effects systemic.
RA inflammation affects your joints through swelling, pain, and potentially joint damage. These are the visible signs of RA inflammation. The inflammation can cause just as many invisible problems systemically.
What extra-articular effects can RA cause and what can you do about it?
Your joints are part of your musculoskeletal system. The other parts of that system is bones and muscle and they can be affected by RA inflammation. Organs is another system in your body that can be affected by RA. Your organs include skin and eyes, salivary glands, internal organs such as heart, lungs, and kidneys, as well as your gastrointestinal system. They also include the vascular system (blood vessels).
And now for the scary part. Whereas joint damage can cause disability, extra-articular RA inflammation can make you very sick, and contribute to an increased risk of death. For instance, historically people with RA have a mortality gap, a 10 year shorter life expectancy than the general population. This is primarily due to the increased risk of heart attack and stroke, caused by systemic inflammation. RA also causes an increased risk of kidney disease, RA lung, as well as vasculitis, an inflammation of the blood vessels.
This all sounds very frightening and you should take this seriously. However, it’s important to know that treating your RA will not just protect your joints, but also the other systems in your body. For instance, studies have shown that the use of TNF blockers, such as Enbrel, significantly reduces the risk of cardiovascular disease. In fact, the longer you take the medications, the more it reduces the risk.
Who gets extra-articular effects?
Approximately 40 percent of people with RA get systemic effects. The development of extra-articular RA is associated with a number of factors. One is gender. Although RA occurs more often in women, extra-articular manifestations occur more often in men who have RA. Furthermore, these types of effects are associated with smoking at the time of diagnosis, as well as severe and active disease, and those who experience early disability.
In addition, certain blood tests can predict of a higher incidence of extra-articular manifestations. Those who test positive for rheumatoid factor have a higher risk. If you are HLA-DR4 positive, you may also have a higher risk. HLA-DR4 is a particular gene that is prevalent in 70 percent of people with RA who are of European ancestry, as compared to 30 percent of the general population.
Does this mean that if you have one of the risk factors, you are doomed to have systemic manifestations of RA? No. These factors mean you have an increased risk, they do not represent a certainty. The knowledge of this can guide how you approach your treatment. For instance, if you have any of these risk factors, you may want to talk to your rheumatologist about being extra vigilant of systemic issues.
A broader view of RA
Historically, the focus in RA care has been exclusively on joints. Unfortunately, even with the increased knowledge about extra-articular effects of RA, some rheumatologists still do not include a broader view in the way they treat their patients. It is important that you and your rheumatologist discuss the systemic effects of RA and how to manage them, so you can protect your whole body from RA inflammation.
This can include making sure you see a preventative cardiologist as soon as possible to discuss ways to manage your risk of heart disease. It's also important to get your eyes checked regularly, and that your doctor monitors your kidney function, as well as blood sugar and cholesterol through regular blood tests. Many rheumatologists rely on your family doctor to keep track of some of these aspects of your health, but general practitioners are not usually aware that such issues are part of RA. Talk to both your rheumatologist and your family doctor about this aspect of your disease.
Although it can be tempting to stick your head in the sand about the extra-articular manifestations of RA, being informed is your ultimate weapon in the fight to control your life. Knowing what you’re dealing with helps you make better decisions about the treatment and management of your RA and enables you push for more comprehensive care.
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