HOD, Rheumatology, Manipal Hospital, Dwarka, New Delhi
Part 8 of 8 in Diagnosis and Management of Rheumatoid Arthritis
Extra-Articular Rheumatoid Arthritis: Lung, Eye, Heart, Kidney and Skin Involvement
September 1, 2024
Rheumatoid arthritis is primarily a joint disease, but a question during the session, relayed and translated for a francophone doctor, asked specifically about organ involvement beyond the joints, particularly the heart.
Which organs can be affected
Dr. Ajmani was clear that extra-articular involvement is rare, but when it happens, it can affect several organ systems: the lungs can develop interstitial lung disease; the eyes can develop scleritis and dryness; the heart, very rarely, can develop pericarditis and pericardial effusion; the kidneys can very rarely be affected by glomerulonephritis or amyloidosis; and the skin can develop vasculitis.
Treating cardiac and other extra-articular involvement
For cardiac involvement specifically, pericarditis or pericardial effusion, Dr. Ajmani's answer was steroids combined with methotrexate. The broader point is that extra-articular disease is uncommon enough that it shouldn't be the first suspicion in a patient with joint symptoms, but should be actively looked for once it's suspected, since involvement of the lungs, heart or kidneys changes the urgency and intensity of treatment.
This article is based on a Jivo Masterclass session conducted by Dr. Sajal Ajmani, HOD, Rheumatology, Manipal Hospital, Dwarka, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Sajal Ajmani taught doctors across Africa on September 1, 2024.
FROM THE LIVE Q&A
Dr. Bafomba
What is the place of pulse or bolus intravenous corticosteroids (solumedrol) in an acute crisis of rheumatoid arthritis, generalised disabling joint pain with high fever?
Dr. Sajal Ajmani
Steroid pulse therapy can be given in severe RA in patients with many swollen and tender joints, usually methylprednisolone 500mg to 1000mg intravenously once a day for one to three days.
Frequently Asked Questions
Beyond the joints, what organs can rheumatoid arthritis affect, particularly the heart, and how is that treated?▼
Extra-articular involvement is rare, but the lungs can develop interstitial lung disease, the eyes can develop scleritis and dryness, the heart very rarely can develop pericarditis and pericardial effusion, the kidneys very rarely can be affected by glomerulonephritis or amyloidosis, and the skin can develop vasculitis. For cardiac involvement specifically, treatment is steroids combined with methotrexate.
What is the recommended medical treatment for palindromic rheumatism?▼
Hydroxychloroquine.
What is the definition of sustained remission?▼
Sustained remission is defined as at least 12 months of remission before any therapy is decreased.
Why does rheumatoid arthritis show a preferential pattern of joint involvement, and why are certain interphalangeal joints spared?▼
DIP (distal interphalangeal) joint involvement is less common in rheumatoid arthritis because there is less synovium in the DIP joints compared to the more commonly affected proximal interphalangeal and metacarpophalangeal joints.
What is the place of pulse or bolus intravenous corticosteroids (solumedrol) in an acute crisis of rheumatoid arthritis, generalised disabling joint pain with high fever?▼
Steroid pulse therapy can be given in severe RA in patients with many swollen and tender joints, usually methylprednisolone 500mg to 1000mg intravenously once a day for one to three days.
What organs can rheumatoid arthritis affect beyond the joints?▼
Rarely, the lungs (interstitial lung disease), eyes (scleritis, dryness), heart (pericarditis, pericardial effusion), kidneys (glomerulonephritis, amyloidosis), and skin (vasculitis).
How is cardiac involvement in RA treated?▼
With steroids combined with methotrexate.
In This Series: Diagnosis and Management of Rheumatoid Arthritis
- 1.Diagnosis and Management of Rheumatoid Arthritis
- 2.Diagnosing Rheumatoid Arthritis: From the 1987 to the 2010 ACR/EULAR Criteria
- 3.Why Rheumatoid Factor and Anti-CCP Alone Don't Diagnose Rheumatoid Arthritis
- 4.Palindromic Rheumatism and Preclinical RA: Recognising Early and Atypical Presentations
- 5.Monitoring Disease Activity: DAS28, SDAI, CDAI and the ACR Response Criteria
- 6.Treat-to-Target: The EULAR 2016 Recommendations and the DMARD Ladder
- 7.Managing Severe Flares: Steroid Pulse Therapy and Achieving Sustained Remission
- 8.Extra-Articular Rheumatoid Arthritis: Lung, Eye, Heart, Kidney and Skin Involvement