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Xeljanz®(tofacitinib citrate) Prescribing information, Enbrel®(etanercept) Prescribing information, Inflectra (infliximab) Prescribing information and Maxtrex(methotrexate) Prescribing information. Adverse event reporting can be found at the bottom of the page.

Rheumatoid Arthritis Manifestations

The physical features of RA manifest inside and outside of the joints. These are sometimes referred to as articular and extra-articular manifestations, respectively.5 In addition, patients with RA have a higher risk of having certain other diseases.8 Co-occurring diseases are referred to as comorbidities.8 Before we describe the manifestations of RA, let’s go over some terminology to discuss joints.

Joint Terminology3Joint terminology3

Joints of the fingers and toes are named based on the bones that meet to make the joint. In the diagrams below, bones are labeled on the left and joints are labeled on the right. Notice that the bones of both the fingers and toes are called phalanges (the singular form of the word phalanges is phalanx). Fingers and toes each have three phalanges except for the big toe and thumb, both of which have two phalanges (ie, no middle phalanx). 

Articular ManifestationsArticular ManifestationsJoints that are affected by RA are characterised by swelling and tenderness. 
  • Smaller joints that are commonly affected include the metacarpophalangeal joints, proximal interphalangeal joints, joints of the wrist, and metatarsophalangeal joints.1
  • ​​​​​Larger joints that may be affected include elbows, shoulders, cervical spine (neck), hips, knees, and ankles.1,5
  • The number and location of involved joints varies across patients.1
  • Deformities can occur over time in the form of  partial dislocations (referred to as subluxations), deformed positions of joints (such as swan neck deformity, boutonniere deformity), and ruptured tendons.3,5
Extra-Articular Manifestations

Some patients with RA show diseases in tissues other than those of the joints.23 These extra-articular manifestations may be the result of chronic systemic inflammation.23 Extra-articular manifestations are associated with a more severe disease course and higher mortality.5,23

Extra-articular manifestations may afflict the following organs and systems:

  • Heart and blood vessels (eg, pericarditis or inflammation of the membrane surrounding the heart)3
  • Eyes (eg, keratoconjunctivitis sicca or dryness of mucous membranes)3 
  • Lungs (eg, interstitial pulmonary fibrosis)
  • Kidneys, skin, nervous system
Additionally, patients with RA may show nodules or lumps especially at pressure areas such as the finger joints and elbows.5 


Patients with RA are at a higher risk of having certain other diseases and conditions.8These comorbidities may contribute to the shorter life spans of patients with RA.8,24 The cause of comorbidities in patients with RA is not known but may include systemic inflammation, medications associated with RA, and associated lifestyle factors such as smoking.24

Common comorbidities include8:

•    Cardiovascular diseases (eg, heart attack and                heart failure)  

•    Cancer (eg, lymphoma, lung cancer, skin cancer)
•    Infections (eg, bacterial, tubercular, fungal, viral)
•    Osteopenia and osteoporosis  

•    Anaemia  

•    Depression

1 - Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010; 69:1580-1588.
3 - Stedman’s medical dictionary for the health profession and nursing: Baltimore Maryland: Lippincott Williams & Wilkins. Illustrated 5th ed. 2005.

5 - Khurana R, Berney SM. Clinical aspects of rheumatoid arthritis. Pathophysiology. 2005; 12:153-165.
8 - Gabriel SE, Michaud K. Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther. 2009; 11(3):229. doi:10.1186/ar2669.
22 - Standring S ed. Pelvic girdle and lower limb: overview and surface anatomy. In: Standring S. ed. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. Chapter 78. Elsevier Limited. 2016. p. 1316-1333.
23 - Gibofsky A. Overview of epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis. Am J Manag Care. 2012; 18(13):S295-S302.
24 - Dougados M, Soubrier M, Antunez A, et al. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis. 2014; 73:62-68.

Travelling with Rheumatoid Arthritis

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Nutrition Guide for RA patients

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