title: Extra-articular manifestations of rheumatoid arthritis: An update.
abstract: Rheumatoid arthritis (RA) is an immune-mediated disease involving chronic low-grade inflammation that may progressively lead to joint destruction, deformity, disability and even death. Despite its predominant osteoarticular and periarticular manifestations, RA is a systemic disease often associated with cutaneous and organ-specific extra-articular manifestations (EAM). Despite the fact that EAM have been studied in numerous RA cohorts, there is no uniformity in their definition or classification. This paper reviews current knowledge about EAM in terms of frequency, clinical aspects and current therapeutic approaches. In an initial attempt at a classification, we separated EAM from RA co-morbidities and from general, constitutional manifestations of systemic inflammation. Moreover, we distinguished EAM into cutaneous and visceral forms, both severe and not severe. In aggregated data from 12 large RA cohorts, patients with EAM, especially the severe forms, were found to have greater co-morbidity and mortality than patients without EAM. Understanding the complexity of EAM and their management remains a challenge for clinicians, especially since the effectiveness of drug therapy on EAM has not been systematically evaluated in randomized clinical trials.
authors.affiliation: Department of Internal Medicine and Clinical Oncology, University of Bari Medical School, Piazza G. Cesare 11, Bari, Italy.
authors.forename: Marcella
authors.initials: M
authors.lastname: Prete
authors.forename: Vito
authors.initials: V
authors.lastname: Racanelli
authors.forename: Liboria
authors.initials: L
authors.lastname: Digiglio
authors.forename: Angelo
authors.initials: A
authors.lastname: Vacca
authors.forename: Franco
authors.initials: F
authors.lastname: Dammacco
authors.forename: Federico
authors.initials: F
authors.lastname: Perosa
mesh_terms: D000686:Amyloidosis / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000473:pathology*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000473:pathology*; D002986:Clinical Trials as Topic; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000473:pathology*; D007596:Joints / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D007668:Kidney / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D008168:Lung / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D009206:Myocardium / Q000276:immunology / Q000473:pathology; D009369:Neoplasms / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000473:pathology*; D009420:Nervous System / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D013163:Splenomegaly / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000473:pathology*; D015996:Survival Rate; D014421:Turkey / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D000893:Anti-Inflammatory Agents