Extra Articular Manifestations of Rheumatoid Arthritis

Medically Reviewed by Dr. Aman Priya Khanna
Written by Rajath R Prabhu, last updated on 15 December 2022| min read
Extra Articular Manifestations of Rheumatoid Arthritis

Quick Summary

Rheumatoid arthritis is a chronic inflammatory disease that can affect the joints and other organs in the body.

Some of the most common extra-articular manifestations of rheumatoid arthritis include:

  • Skin problems, such as rheumatoid nodules and vasculitis
  • Eye problems, such as uveitis and scleritis
  • Lung problems, such as pleuritis and interstitial lung disease
  • Cardiac problems, such as pericarditis and heart valve disease
  • Neurological problems, such as peripheral neuropathy and cognitive impairment

The treatment of extra-articular manifestations of rheumatoid arthritis depends on the specific symptoms and organ involved.

Rheumatoid Arthritis is defined as a chronic inflammatory disease that primarily affects the joints. It can, however, also cause a wide range of extra-articular manifestations (EAMs), which are signs and symptoms that occur outside the joints. EAMs can affect any organ in the body, varying in severity from mild to life-threatening. While some people with RA only experience EAMs, others may experience both joint and EAM symptoms.

This blog post will discover some of the most common extra-articular manifestations of rheumatoid arthritis and their causes and treatments.

What are Extra-Articular Manifestations of Rheumatoid Arthritis?

Rheumatoid Arthritis is an inflammatory disorder affecting more than just the joints. Some of the common extra-articular manifestations of Rheumatoid Arthritis are peripheral neuropathy, which damages the nerves outside the brain and spinal cord. Other extra-articular manifestations include skin problems, eye problems, and gastrointestinal issues.

While these clinical manifestations of rheumatoid arthritis can be extremely painful and debilitating, treatments are available to help manage them. If you are living with rheumatoid arthritis, always consult your doctor about your symptoms to get the best possible treatment.

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Common Extra-Articular Manifestation of RA

The most common extra-articular manifestation of RA is inflammation of the eyes, which can lead to redness, pain, and blurred vision. Other most common extra-articular manifestations of rheumatoid arthritis include inflammation of the lungs, heart, and blood vessels. RA can also cause fatigue, weight loss, anaemia, and bone loss.

Extra-articular manifestations of rheumatoid arthritis can be mild or severe and occur at any time throughout the disease. Treatments for extra-articular manifestations vary depending on the symptom or condition being treated. However, many treatments for extra-articular manifestations are similar to those used to treat RA itself, such as anti-inflammatory medications and disease-modifying antirheumatic drugs (DMARDs).

Neuropathy: Neurological Manifestations of RA

Neuropathy, or nerve damage, is a common neurological manifestation of rheumatoid arthritis (RA).

  1. RA can cause damage to the nerves in any part of the body but most commonly affects the peripheral nerves. This can lead to a variety of symptoms, including pain, numbness, tingling, and weakness.
  2. Peripheral neuropathy is typically caused by inflammation of the blood vessels that supply the nerves. This results in decreased blood flow and oxygenation to the nerves, which can then lead to damage. RA-related neuropathy can also be caused by direct damage to the nerve cells.
  3. The most common symptom of RA-related neuropathy is pain. This pain often ranges from mild to severe and may be constant or intermittent. It is often described as burning, tingling, or shooting. Other common symptoms include numbness, tingling, and weakness. These symptoms can make everyday activities difficult or impossible to perform.

If you are experiencing any neurological symptoms, you must see your doctor for an evaluation. If left untreated, neuropathy can cause permanent damage to the nerves. With proper treatment, however, many people with RA are able to live normal lives despite their condition.

CNS Disease: Neurological Manifestations Of RA

Carpal Tunnel Syndrome, occurring when the median nerve becomes compressed at the wrist, is also a neurological manifestation of RA. This can cause numbness, pain and tingling in the fingers and hand. RA can also cause cognitive impairment and dementia, although this is more commonly seen in older patients with long-standing diseases. In some cases, RA may also lead to seizures.

Treatment for neurological manifestations of RA typically involves a combination of medications and physical therapy. If carpal tunnel syndrome is severe, surgery will be required for pressure release on the median nerve. For other neurological problems caused by RA, treatment focuses on relieving symptoms and preserving function as much as possible.

Myelopathy: Neurological Manifestations of RA

Myelopathy is a disorder of the spinal cord that can occur as a result of RA. It is characterised by progressive weakness and loss of sensation in the arms and legs. In some serious cases, it may lead to paralysis. Myelopathy can also cause problems with balance and coordination, as well as bladder and bowel dysfunction.

While myelopathy is relatively rare in people with RA (affecting less than 1% of those with the disease), it is still essential to be aware of this potential complication. 

Other neurological manifestations of RA include:

  1. Peripheral neuropathy (nerve damage in the extremities).
  2. Myopathy (muscle weakness).
  3. Cranial nerve palsies (weakness or paralysis of cranial nerves).

If you experience any neurological symptoms, be sure to discuss them with your doctor so that they can rule out other potential causes and provide the appropriate treatment.

Ophthalmic Manifestations of RA

The ophthalmic manifestations of RA are typically nonspecific and can include dry eye, uveitis, scleritis, and episcleritis. Dry eye is the most common ocular manifestation of RA and can be caused by the inflammation associated with the disease. Uveitis is another common manifestation of RA and can cause pain, redness, and photophobia. Scleritis and episcleritis are less common but can also be seen in patients with RA. Treatment for the ocular manifestations of RA typically includes artificial tears and anti-inflammatory medications.

Skin Manifestations of RA

Skin disease is among the most common clinical manifestations of rheumatoid arthritis. About one-third of people with RA will experience some form of skin disease at some point during their disease. The most common skin manifestations of RA include:

  1. Rashes: Rashes are a prevalent symptom of RA and can occur anywhere on the body. They may be itchy, dry, or scaly and can vary in severity from mild to severe.
  2. Raynaud's phenomenon: This is a condition where the blood vessels of your fingers and toes compress in response to cold or stress. This may turn your fingers and toes white or blue and can be painful.
  3. Nodules: Nodules are firm lumps that can form under the skin, often around joints. They are usually painless but can sometimes be tender.
  4. Vasculitis: Vasculitis is an inflammation of the blood vessels that can lead to ulcers, gangrene, and even death if left untreated. It is a serious complication of RA, but fortunately, it is relatively rare.

Hematologic Manifestation of RA

When rheumatoid arthritis (RA) progresses, it often leads to changes in blood cells and in the way the blood clots. This can cause a wide range of problems, including anaemia (deficient red blood cell count), leukopenia (deficient white blood cell count), thrombocytopenia (low platelet count), and/or bleeding.

In some cases, RA can also cause autoimmune hemolytic anaemia, which is when the immune system attacks red blood cells. This can lead to symptoms like fatigue, shortness of breath, and dizziness. If you witness any of these symptoms, you must see your doctor immediately so they can check your blood counts and determine if you have this condition.

Left untreated, RA-related hematologic problems can become serious or even life-threatening. That's why it's significant to see your doctor regularly if you have RA, so they can check your condition and treat any complications that arise.

Pulmonary Manifestations of RA

The most common pulmonary manifestation of RA is interstitial lung disease (ILD). ILD is a group of disorders involving inflammation and lung scarring. This can lead to symptoms such as breathlessness, cough, and fatigue. RA patients are at an increased risk for developing ILD, and it is estimated that up to 10 per cent of people with RA will eventually develop this condition.

While ILD is RA's most common pulmonary manifestation, other potential problems exist. For example, people with RA may be at an increased risk for pneumonia due to the inflammation caused by the disease. The medications used to treat RA can also cause side effects in the lungs, such as bronchitis or pneumonitis.

If you have RA and are experiencing any respiratory symptoms, you must see your doctor immediately. Pulmonary manifestations of RA can be severe and even life-threatening, so prompt diagnosis and treatment are imperative.

Cardiac Manifestations of RA

Cardiac clinical manifestations of Rheumatoid arthritis are rare but can be serious. They include pericarditis, i.e., inflammation of the sac around the heart; myocarditis, i.e., inflammation of the heart muscle; and endocarditis, i.e., inflammation of the lining of the heart. These conditions can lead to chest pain, irregular heartbeat, and even heart failure. Treatment typically involves anti-inflammatory medications and, in some cases, surgery.


The clinical manifestations of rheumatoid arthritis can be just as debilitating as joint pain and inflammation. Knowing all the potential complications is essential to seek treatment early and prevent them from worsening. If you are experiencing the symptoms described in this article, visit your doctor and get a complete diagnosis and treatment plan.

Whether you need a complete checkup from a certified rheumatologist or want to diagnose your extra-articular manifestations of RA, HexaHealth is the one-stop destination for all medical concerns. From diagnosis to aftercare, experts at HexaHealth handhold you through the entire journey of your treatment. Get in touch with a HexaHealth expert today!

Suggested Reads:

  1. Rheumatoid Arthritis
  2. Homeopathic Medicine for Rheumatoid Arthritis

Frequently Asked Questions

Some joints are affected more commonly than others, such as the hands, wrists, knees, and ankles.

One of the most common neurologic manifestations of RA is peripheral neuropathy, which can cause numbness, tingling, and weakness in the hands and feet.

Extra-articular joint pain is any type of pain that occurs outside of the joints. This can include muscle pain, ligaments, tendons, and other tissues surrounding the joints.

Several systemic manifestations are associated with rheumatoid arthritis, including fatigue, weight loss, anaemia, and subcutaneous nodules. Additionally, patients may experience fever, malaise, and poor appetite. In more severe cases, patients may also develop pleurisy or pericarditis.

Extra-articular manifestations are features of psoriatic arthritis that occur outside of the joints. They can include skin and nail changes, as well as inflammation in other body parts, such as the eyes, lungs, and gut.

Updated on : 15 December 2022

Disclaimer: The information provided here is for educational and learning purposes only. It doesn't cover every medical condition and might not be relevant to your personal situation. This information isn't medical advice, isn't meant for diagnosing any condition, and shouldn't replace talking to a certified medical or healthcare professional.


Dr. Aman Priya Khanna

Dr. Aman Priya Khanna

MBBS, DNB General Surgery, Fellowship in Minimal Access Surgery, FIAGES

12 Years Experience

Dr Aman Priya Khanna is a well-known General Surgeon, Proctologist and Bariatric Surgeon currently associated with HealthFort Clinic, Health First Multispecialty Clinic in Delhi. He has 12 years of experience in General Surgery and worke...View More


Rajath R Prabhu

Rajath R Prabhu

MSc. Clinical Research I PG Diploma in Public Health Services Management

3 Years Experience

His work in medical content writing and proofreading is noteworthy. He has also contributed immensely to public health research and has authored four scientific manuscripts in international journals. He was assoc...View More

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