Extra-articular manifestations of rheumatic disease
The mechanisms behind constitutional, skin, eye and internal organ features of rheumatic disease, from IL-6, hepcidin and serum amyloid A to immune complexes, transplacental anti-Ro and the IL-23/IL-17 axis at entheses, with a worked rheumatoid pleural fluid and the patterns examiners pair with each disease.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Extra-articular disease is where rheumatic illness kills: interstitial lung disease, cardiovascular disease, vasculitis, amyloid and infection account for much of the excess mortality in RA and SLE.
- A handful of mechanisms explain most of it: cytokines (IL-6, TNF, IL-1), immune complex deposition (type III), pathogenic autoantibodies (type II), inflammation at mechanically stressed sites (IL-23/IL-17) and drug effects.
- Extra-articular RA is linked to seropositivity (RF, anti-CCP), smoking, male sex and long-standing active disease.
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Sources
- Kelley and Firestein's Textbook of Rheumatology (11th ed.)Elsevier (Firestein, Budd, Gabriel, Koretzky, McInnes, O'Dell, 2021), 2021
- Therapeutic Guidelines: RheumatologyAU/NZTherapeutic Guidelines Ltd, accessed November 2026
- Conforti A et al. Beyond the joints, the extra-articular manifestations in rheumatoid arthritis. Autoimmun Rev 2021;20:102735Autoimmunity Reviews, 2021
- Light RW. Pleural effusions. Med Clin North Am 2011;95:1055-70Medical Clinics of North America, 2011
- Ganz T. Anemia of inflammation. N Engl J Med 2019;381:1148-57New England Journal of Medicine, 2019
- Brito-Zerón P et al. Autoimmune congenital heart block: complex and unusual situations. Lupus 2016;25:116-28Lupus, 2016
- Last updated
- 14 November 2026
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