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🌱 來自: clinical manifestations of rheumatoid arthritis

extra-articular manifestations of rheumatoid arthritis

(18-41% of Pts) can occur at ↣ any time; ↑ frequency in seropositive (⊕ RF or anti-CCP) and w/ active disease (Autoimmun Rev 2021;20:102776)

Skin

• Rheumatoid nodules (20-30%, usually seropositive):
  • extensor surface, bursae;
  • can be in lung, heart, sclera
• Raynaud’s → Raynaud phenomenon, pyoderma gangrenosum,
  • cutaneous vasculitis (ulcers, purpura, etc.)

Pulm

• ILD (associated with MUC5B mutations),
• airway disease, pleuritis, effusions (low glucose), nodules, pulmonary hypertension;
• precedes joint symptoms in 20% of cases;
• RA medication toxicity (MTX, ? anti-TNF, & anti-CD20)

CV

• Accelerated atherosclerosis with increased risk of MI & CV death, AF, pericarditis (effusions in 1/3 of seropositive cases), myocarditis, coronary/systemic vasculitis

Nervous

• Nerve entrapment (e.g., carpal tunnel), stroke, mononeuritis multiplex, CNS vasculitis

Ocular

• 鞏膜炎、結膜炎：Scleritis, episcleritis, keratoconjunctivitis sicca (secondary Sjögren’s)

Heme

• Anemia of chronic disease, neutropenia (Felty’s syndrome: 1%, typically long-standing RA + splenomegaly; large granular lymphocyte leukemia: bone marrow infiltrated with lymphocytes ± myeloid hypoplasia), NHL, amyloidosis

Renal

• Glomerulonephritis (usually mesangial), nephrotic syndrome (secondary amyloidosis), nephrotoxicity from RA medications

Vasculitis

• Small & medium vessels (usually high RF titer, long-standing RA); pericarditis, ulcers, scleritis, & neuropathy most common