Rheumatoid arthritis (RA): Extra-articular manifestations

Skin: 

 • Inflammation of skin (esp. over areas of stress) forms large necrotizing granulomas under skin -> Rheumatoid Nodules

 • Auto-immune attack on hair follicles -> Alopecia

 • Auto-immune attack on blood vessels (vasculitis) Decr delivery of blood to limbs (esp legs) -> Leg Ulcers, Livedo reticularis

Blood: Anemia

Eyes:

 • Globe inflammation (Scleritis, Episcleritis) -> Sudden eye pain, Sclera may perforate!

 • Lymphocytic infiltration damages tear glands -> Dry Eyes (xeropthalmia)

Mouth:

 • Lymphocytic infiltration damage salivary glands -> Dry mouth (Xerostomia)

Heart:

 • Inflammation of pericardium (Pericarditis) -> Chest Pain worse when supine, friction rub audible

Lungs:

 • Inflammation of pleural membranes irritates pleural nociceptors & induces fluid extravasation -> Dyspnea, pleuritic chest pain, pleural effusion on CXR

 • RA inflammation tends to cause interstitial lung disease/pulmonary fibrosis (mechanism unknown)  -> Dyspnea + dry cough, Crackles on auscultation



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