Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Autoimmun Rev. 2021 Feb;20(2):102735. doi: 10.1016/j.autrev.2020.102735. Epub 2020 Dec 17.
Rheumatoid arthritis (RA) is an inflammatory disease typically affecting the joints, but the systemic inflammatory process may involve other tissues and organs. Many extra-articular manifestations are recognized, which are related to worse long outcomes. Rheumatoid nodules are the most common extra-articular feature, found in about 30% of patients. Secondary Sjögren's syndrome and pulmonary manifestations are observed in almost 10% of patients, also in the early disease. Active RA with high disease activity has been associated with an increased risk of such features. Male gender, smoking habit, severe joint disease, worse function, high pro-inflammatory markers levels, high titer of rheumatoid factor, and HLA-related shared epitope have been reported as clinical predictors of occurrence of these rheumatoid complications. In addition, there is a little evidence deriving from randomized controlled trials in this field, thus the therapeutic strategy is mainly empiric and based on small case series and retrospective studies. However, considering that these extra-articular manifestations are usually related to the more active and severe RA, an aggressive therapeutic strategy is usually employed in view of the poor outcomes of these patients. The extra-articular features of RA remain, despite the improvement of joint damage, a major diagnostic and therapeutic challenge, since these are associated with a poor prognosis and need to be early recognized and promptly managed.
类风湿关节炎（RA）是一种炎症性疾病，通常影响关节，但全身性炎症过程可能涉及其他组织和器官。许多公认的关节外表现与较差的长期预后有关。类风湿结节是最常见的关节外特征，约 30%的患者存在。继发性干燥综合征和肺部表现几乎见于 10%的患者，也见于早期疾病。高疾病活动度的活动性 RA 与这些特征的发生风险增加有关。男性、吸烟习惯、严重的关节疾病、较差的功能、高促炎标志物水平、高滴度类风湿因子和 HLA 相关共享表位被报道为这些类风湿并发症发生的临床预测因素。此外，在该领域还很少有来自随机对照试验的证据，因此治疗策略主要是经验性的，基于小病例系列和回顾性研究。然而，考虑到这些关节外表现通常与更活跃和严重的 RA 相关，鉴于这些患者的预后较差，通常采用积极的治疗策略。尽管关节损伤得到改善，但 RA 的关节外表现仍然是一个主要的诊断和治疗挑战，因为这些表现与预后不良有关，需要早期识别并及时处理。
