77

Rheumatoid arthritis (RA) is a chronic inflammatory rheumatic disease which can affect almost every system in the body. The progression of the disease varies considerably from patient to patient. Some patients experience mild disease; however, in the majority of patients, the disease leads to progressive joint destruction and disability. In addition to joint symptoms, RA can be associated with extra-articular manifestations; these are rarely the first symptoms to appear and are generally associated with more severe forms of the disease. The extra-articular involvement of RA is highly variable, ranging from rheumatoid nodules (the most common symptom) to rheumatoid vasculitis, which is associated with significant morbidity and mortality (49% at five years). Systemic symptoms may dominate joint manifestations in some individuals and may precede joint involvement. Men are more likely to develop severe systemic involvement and have higher mortality from such complications. Systemic manifestations can be divided into general and organ-specific manifestations; the former often occur early in the disease, while the prevalence of the latter is greater in patients with severe, long-term RA. Specific extra-articular features are common, although their incidence may now be decreasing with the use of more aggressive treatment of the disease in its early stages.