1. Rheumatoid Arthritis and Your Organs
Dr Chandini Rao
Consultant Rheumatologist

2. Overview Extra-articular manifestations of RA Comorbidities
What can we do to prevent organ damage?
Quiz….

3. Organ Involvement in RA
Is not inevitable
Is much less common than it used to be
Needs to be looked for
Can be prevented
Control of inflammation
Management of associated risk factors

5. Organ Involvement Extra-articular features: Comorbidities:
Effects of RA outside the joints
Comorbidities:
Separate conditions that are seen more commonly in people with RA

6. Extra-articular Features of RA - General
Fatigue
Loss of appetite / weight loss
Fever
Depression
Due to raised levels of inflammatory chemicals in the bloodstream

8. Extra-articular Features of RA - Skin

9. Extra-articular Features of RA - Eyes
Dry eyes (secondary Sjogren’s Syndrome)
Inflammation:
Scleritis
Episcleritis
Uveitis
Corneal scarring
(Cataracts)
(Glaucoma)

11. Extra-articular Features of RA - Lungs
Inflammation of lung tissue – “interstitial lung disease”
Fluid around the lung – “pleural effusion”
Rheumatoid nodules within the lung

13. Extra-articular Features of RA - Heart
Inflammation of heart lining – “pericarditis”
Inflammation of heart muscle – “myocarditis”
Inflammation of blood vessels in the heart – “coronary vasculitis”

14. Extra-articular Features of RA – Nervous System
Inflammation / damage to nerves – “neuropathy”
Inflammation / damage to spinal cord – “myelopathy”

16. Extra-articular Features of RA - Kidneys
Inflammation of kidney – “nephritis”
Prolonged systemic inflammation  amyloidosis

17. Extra-articular Features of RA - Blood
Low red blood cells – “anaemia”
Blood loss
Medication
Autoimmune
Low white blood cells /platelets

18. Extra-articular Features of RA – Felty’s Syndrome

20. Comorbidities in Rheumatoid Arthritis - Osteoporosis
Reduced bone density / weaker bone structure
Increased risk of low-trauma fracture
Risk factors:
Prolonged high disease activity
Immobility
Steroids
Smoking

21. Comorbidities in Rheumatoid Arthritis – Cardiovascular Disease
Increased risk of heart attacks and strokes
Risk Factors:
Prolonged high disease activity
Immobility / lack of exercise
Smoking
Steroids

23. Comorbidities in Rheumatoid Arthritis – Mental Health
Increased risk of anxiety and depression:
Diagnosis of a long term condition
Concerns about future
Concerns about ability to work
Personal relationships
High levels of disease activity
Medications

28. Prevention 1 Early diagnosis and treatment of RA
Early Arthritis Clinics
GP awareness
Public awareness

29. Prevention 2 Tight control of disease activity
Regular assessments / treatment escalation
DMARDs
Biologics

30. Prevention 3 Annual Review Clinics
Assessment of disease activity (DAS)
Screening for complications
FRAX questionnaire for osteoporosis
QRISK2 calculation for heart disease risk
PHQ-9 questionnaire for anxiety and depression

31. Prevention 4 Lifestyle modification Smoking cessation
Weight management
Healthy diet
Regular exercise

32. Thank You!