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Extra-Articular Rheumatoid Arthritis: Causes, Symptoms, and Treatment

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Extra-articular rheumatoid arthritis occurs due to genetic and environmental factors. Read this article to learn more.

Medically reviewed by

Dr. Suman Saurabh

Published At April 13, 2023
Reviewed AtApril 19, 2023


Millions of people worldwide suffer from debilitating chronic autoimmune disorder known as extra-articular rheumatoid arthritis (RA). It is characterized by inflammation, joint pain, and swelling in the joints. Extra-articular rheumatoid arthritis is caused by a combination of genetic and environmental factors. However, the exact cause is still unknown, which makes it difficult to diagnose.

Once diagnosed, RA can be treated with a variety of medications, therapies, and lifestyle changes such as exercise and getting enough rest. It can also help reduce joint pain and swelling, as well as slow down the progression of disease. To help people understand extra-articular rheumatoid arthritis and how it can be properly managed, the causes, symptoms, and treatments are discussed in this article.

What Is Extra-Articular Rheumatoid Arthritis?

Extra-articular rheumatoid arthritis (RA) is a form of autoimmune arthritis and is the second-most common type of RA. It is a chronic, progressive systemic illness that affects more than 1.5 million adults in the United States alone. This type of RA causes inflammation and pain in areas that are outside the joint itself, including the skin, eyes, and blood vessels. Although the exact cause of extra-articular RA is unknown, it is thought to be an autoimmune condition in which an individual's immune system mistakenly attacks healthy cells and tissues. In turn, this results in inflammation, which has the potential to affect other body parts, such as:

The Eyes: Inflammation of the sclera (the white area around the iris) or uveitis (inflammation inside the eye).

Lungs: Shortness of breath or difficulty breathing.

Nerves: Numbness or tingling in certain areas.

Skin: Rash or sensitivity to sunlight.

Blood vessels: Vasculitis (inflammation of blood vessels).

It is important to note that extra-articular RA tends to be milder than other forms of RA but can still cause significant pain and disability if not treated properly.

What Causes Extra-Articular Rheumatoid Arthritis?

Extra-articular rheumatoid arthritis (ERA) is a condition that affects the body outside of the joints and is caused by an autoimmune disorder, meaning the immune system attacks healthy tissue. Although the exact cause is unknown, there are risk factors that can increase an individual's likelihood of developing ERA. These include:

Genetics – Having an aunt, uncle, or parent that has had ERA can increase the chances of developing it as well.

Age – Those over the age of 50 are more susceptible to ERA.

Sex – Women are more likely to develop ERA than men.

Location – Some areas have higher levels of environmental exposure, such as air pollution and industrialization, which can increase one's risk for ERA.

Smoking – Evidence suggests that smoking increases the risk of developing ERA.

It is important to note that having any or all of these risk factors does not mean people will definitely develop ERA; however, understanding what puts people at greater risk can help them take preventive measures and discuss with their doctor how to best protect their health.

What Are the Symptoms of Extra-Articular Rheumatoid Arthritis?

Extra-articular rheumatoid arthritis (ERA) can cause a range of symptoms, some of which may be similar to those experienced with other forms of arthritis. It is important to note, however, that its symptoms can differ from other types of arthritis and can have a lasting impact on one's physical and emotional health. Here are the most common symptoms associated with ERA:

Joint Pain and Inflammation: The primary symptom of ERA is joint pain and inflammation. The joints affected are typically those located away from the main joints such as the wrists, ankles, hands, knees, elbows and shoulders. Additionally, it is possible for pain and inflammation to spread further away from the affected joints because ERA affects connective tissues like tendons and ligaments.

Involuntary Movements: A key symptom of ERA is muscle contractions or twitching which results in involuntary movements appearing in affected joints or muscles. These contractions can be rapid or slow and may occur sporadically or become more frequent over time.

Fatigue: People with ERA frequently complain of fatigue, which can be mentally and physically taxing. This fatigue is often accompanied by feelings of exhaustion or sluggishness when attempting to engage in everyday activities.

It is important for individuals living with ERA to seek out medical advice from their healthcare provider if any of these symptoms occur in order to receive an accurate diagnosis and an appropriate treatment plan.

What Are the Treatments for Extra-Articular Rheumatoid Arthritis?

The goal of treatment for extra-articular rheumatoid arthritis is to reduce inflammation and pain, prevent joint damage, and improve mobility and quality of life. Looking toward the seriousness of the condition, people and their primary care physician might settle on at least one of the accompanying medicines:

Nonsteroidal Anti-inflammatory Drugs (NSAIDs): NSAIDs are the most common type of medication used to treat RA. They help reduce inflammation in the joints, relieving stiffness, soreness, and pain. Common NSAIDs include:

  • Ibuprofen (Advil).

  • Naproxen sodium (Aleve).

  • Celecoxib (Celebrex).

  • Diclofenac (Voltaren).

Corticosteroids: Strong anti-inflammatory medications like corticosteroids like Prednisone can be taken orally or injected into the affected joint. They provide quick relief from inflammation but have potential side effects if taken for an extended period of time.

Disease-Modifying Antirheumatic Drugs (DMARDs): DMARDs help reduce inflammation by suppressing the immune system. They can be effective in controlling inflammation in RA patients but take several weeks to take effect. Common DMARDs include:

  • Hydroxychloroquine (Plaquenil).

  • Leflunomide (Arava).

  • Sulfasalazine (Azulfidine).

Biologic Response Modifiers: Biologic response modifiers, also known as biologics, are a type of DMARD that target specific parts of the immune system involved in RA. Examples include Adalimumab and Etanercept.

How to Prevent Extra-Articular Rheumatoid Arthritis?

Extra-articular rheumatoid arthritis is an inflammatory condition that can be difficult to manage. Fortunately, people can take steps to avoid or lessen the signs and symptoms of this condition.

Eat a Balanced Diet: Preventing extra-articular rheumatoid arthritis requires a well-balanced diet. Include a lot of fruits and vegetables in your diet, as well as foods high in omega-3 fatty acids like nuts, seeds, and fatty fish. Limiting processed foods and sugar can also be beneficial for those with extra-articular rheumatoid arthritis.

Exercise Regularly: Regular physical activity helps decrease inflammation and strengthens muscles, helping to reduce joint pain associated with extra-articular rheumatoid arthritis. People do not have to do everything at once; they just need to start with light stretching and walking a few times a week and work their way up from there.

Reduce Stress Levels: Stress can cause flare-ups in those with extra-articular rheumatoid arthritis, so it is important to take steps to reduce stress levels. Taking breaks during the day, getting enough sleep, focusing on positive thoughts, and incorporating relaxation techniques like yoga into the routine can all help keep stress levels in check.

Managing the Disease and Living With Extra-Articular Rheumatoid Arthritis: When it comes to managing extra-articular rheumatoid arthritis, there are several things that people can do in order to improve their quality of life. It is important to remember that even with the most aggressive treatment options, there is no cure for the condition and its effects will be long-term.

However, with small lifestyle changes, people can still lead happy and fulfilling lives. Here are some tips for managing extra-articular rheumatoid arthritis:

Exercise Regularly - Building strength and flexibility in the muscles through exercise can help reduce inflammation and stiffness, making movement easier and less painful.

Get Adequate Rest - Resting gives the body an opportunity to heal and recharge, reducing pain and fatigue associated with the condition.

Eat a Balanced Diet - Eating healthy will help keep the body strong and provide people with the energy needed to manage their condition on a daily basis.

Make Lifestyle Changes - Small changes that people make in order to reduce stress on joints, such as using ergonomic tools or devices make activities like cooking and cleaning easier.

Talk to a Doctor - A doctor can provide advice on treatment options such as medications, physical therapy, or lifestyle modifications that can help manage the pain of extra-articular rheumatoid arthritis.


With a deeper understanding of extra-articular rheumatoid arthritis, people can now make an informed decision about how best to care for themselves if they have this condition. The causes, symptoms, and treatment options are all factors that need to be considered, along with the overall health and lifestyle. From utilizing the latest methods of disease-modifying therapies to understanding the importance exercise and physical therapy to reduce joint stiffness, there are many strategies that can be useful in managing symptoms. An important factor in dealing with this condition is being aware of any changes in health and consulting with a healthcare professional if new or worsening symptoms are experienced. Early diagnosis and treatment are key factors in the reducing the impact of extra-articular rheumatoid arthritis on health.

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Dr. Suman Saurabh
Dr. Suman Saurabh

Orthopedician and Traumatology


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