The extra-articular features of rheumatoid arthritis: A systematic analysis of 127 cases

A systematic analysis was undertaken of 127 hospitalized patients with definite or classic rheumatoid arthritis. Of the group studied 76 per cent had one or more extra-articular feature including nodules, pulmonary fibrosis, digital vasculitis, skin ulceration, lymphadenopathy, noncompressive neuropathy, splenomegaly, episcleritis or pericarditis. The presence of one or more of these features correlated with signs of persistent articular inflammation, roentgenologic stages of more severe joint disease and the presence of soluble immune complexes and high titers of rheumatoid factor. They did not appear to be related to the use of corticosteroids or to the duration of rheumatoid disease. On follow-up of the total group of patients after five years a mortality of 20 per cent was found. This was twice as great in the group with extra-articular features and was particularly striking in patients 50 years of age or less. These results obtained in hospitalized patients indicate that the manifestations of rheumatoid arthritis form a spectrum in which extra-articular features should be considered as classic criteria of rheumatoid arthritis. Furthermore, these extra-articular features appear to have an important bearing on prognosis.