Rheumatoid arthritis is an autoimmune rheumatic disease in which structures such as joints are attacked, causing a very characteristic form of arthritis due to its deforming character.
The manifestations that accompany this disease are not limited to the joints. This type of arthritis can lead to the development of lesions in other organs and systems, which are its extra-articular manifestations. These are present in approximately 50% of patients with rheumatoid arthritis.
Main extra-articular manifestations of rheumatoid arthritis
This rheumatic disease is accompanied by a large number of manifestations at the systemic level. They are due to the activity of autoantibodies caused by a failure in the immune system that recognizes various components of the tissue as foreign.
These manifestations are more frequent in patients who have elevated levels of rheumatoid factor in the blood, which reflects greater activity of the disease. These manifestations generally warrant specific treatment.
The heart and blood vessels are one of the most affected organs in people with rheumatoid arthritis.
It is common for these patients to present an inflammatory process located inside the small caliber arteries, this is known as vasculitis and it leads to them becoming obstructed, thus compromising the passage of blood inside them, which produces small infarcts in the tissues irrigated by them. Vasculitis can cause peripheral nerve disorders, manifesting primarily as paralysis, loss of sensation, or pain.
The heart, on the other hand, is usually affected by lesions in the valves that separate the atria from the ventricles and in those that are located at the origin of the pulmonary arteries and aorta. This favors the appearance of arrhythmias and heart failure.
Chronic diseases can lead to various adaptive changes in the body, including anemia.
In addition to red blood cells, another blood cell series that is frequently affected by this disease is platelets. This is mainly related to malfunctions in the spleen that lead to this organ accumulating them inside, thus reducing its blood levels, which favors the development of bleeding.
Finally, the immune response can lead to a decrease in white blood cells, or it favors the development of infections.
One of the most common extra-articular manifestations of rheumatoid arthritis is the appearance of nodular lesions in the lungs.
In addition to these injuries, the lungs can be affected by the development of fibrosis that limits their ability to expand during inspiration. Another associated problem is the development of dilatations of the intrapulmonary bronchi called bronchiectasis, these are due to the destruction of the cartilage of the bronchial wall, which favors the accumulation of secretions that constitute a factor that increases the risk of suffering from infectious processes such as pneumonia.
Antibodies often produce inflammatory processes that can stimulate the exudation of fluids in virtual spaces located between the membranes that line the heart, lungs and intestines, known as the pericardium, pleura and mesentery respectively.
Rheumatic diseases are usually accompanied by eye lesions that cause manifestations such as redness and eye pain. These are generally due to involvement of the white part of the eyeball known as the sclera.
In the case of rheumatoid arthritis, the main manifestation is dry eyes.
Subcutaneous tissue disorders
It is estimated that about 30% of people with rheumatoid arthritis have nodular lesions that are soft and painful to the touch, located under the skin at the level of the forearms and legs.
These injuries are known as rheumatic nodules. They are due to localized activation of the immune system on necrotic collagen fibers, probably due to a vasculitis-type process.
Nodules are rarely infected or ruptured, necessitating their removal.
People with rheumatoid arthritis can develop atrophy of the muscles near the most compromised joints. This disorder is related to the necrosis of muscle fibers, which produces a decrease in muscle mass that gives rise to manifestations such as weakness.
In addition to the bone destruction typical of the disease activity, this form of arthritis predisposes to a decrease in bone mineral density, producing osteoporosis. This is usually aggravated as a result of the adverse effect of medications such as steroids.
Increased risk of developing tumors
Rheumatoid arthritis increases the risk of developing tumors such as lymphomas, especially in patients with active disease with persistent inflammation.
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