RxPG - List of Extra-articular Complications of Rheumatoid Arthritis

The following is a list of Extra-articular Complications of Rheumatoid Arthritis

Amyloidosis

Secondary amyloidosis should be suspected in RA patients who develop proteinuria, renal failure, gastrointestinal symptoms, myocardiopathy and/or hepatomegaly, and in those having elevated phase reactants concurrent with little clinical activity.

Anemia

Anemia in RA is usually asymptomatic, therefore periodic blood cell counts should be obtained including erythrocyte, leukocyte and platelet counts, calculation of the mean corpuscular volume (MCV), reticulocyte count, and general liver and kidney function tests.

Cardiological complications

Cardiac involvement should be suspected in the presence of pericardial-type pain, heart failure, or conduction abnormalities. The two most frequent complications are pericarditis and myocarditis.

Osteoporosis

Osteoporosis should be suspected in the presence of vertebral or peripheral fractures not due to trauma. When RA is first diagnosed, all patients should be evaluated for the main risk factors for fracture and loss of bone mass; this analysis should include both RA-associated and independent risk factors.

Pulmonary complications

The presence of pleuritic pain, dyspnea, or hemoptysis is suggestive of pulmonary disease in RA patients. Pulmonary complications may include pleural disease, rheumatoid nodules, interstitial fibrosis, or bronchiolitis obliterans with organizing pneumonia.

Felty’s syndrome

Felty’s syndrome is indicated by the presence of splenomegaly, leukopenia (< 3,500/mm3), and neutropenia (<2,000/mm3) in patients meeting RA criteria.

Secondary Sjögren’s syndrome

A patient with RA is considered to have secondary Sjögren’s syndrome (SSS) if there are signs and symptoms indicative of xerophthalmia and xerostomia.

Vasculitis

Rheumatoid vasculitis is understood to be a set of vascular processes (periungual splinter hemorrhages, palpable purpura, polyarteritis nodosa) with variable outcome and treatment.

References:

1. Clinical practice guideline for the management of rheumatoid arthritis.

2. GUIPCAR Group. Clinical practice guideline for the management of rheumatoid arthritis. Madrid: Spanish Society of Rheumatology; 2001. 170 p. [430 references]