Systemic Involvement Sample Clauses

Systemic Involvement. RA is a chronic inflammatory arthritis and most commonly affects the joints, however, RA can be a systemic disease and severe arthritis shortens life expectancy by 6-10 years, equivalent to the impact of diabetes, Hodgkin’s disease, and triple vessel coronary artery disease. [Xxxxxx et al. 1981] Systemic or extra-articular manifestations of RA are present in approximately 8-12% of patients and there is evidence that those patients with systemic manifestations have increased morbidity and mortality compared to those with no extra articular features. [Xxxxxxxx et al. 1999] The extra-articular manifestations are often associated with high levels of disease activity, high inflammatory markers and high levels of rheumatoid factor. These patients are known to have a poor prognosis and therefore early aggressive therapy should be instituted to lower the risk of systemic manifestations and reduce morbidity and mortality. [Xxxxxxxx et al. 2002] Constitutional features include fatigue, fever, anorexia and weight loss. Many of the systemic features are driven by IL-6; it activates the hypothalamic-pituitary-adrenal (HPA) axis to produce fever, stimulates haematopoiesis, including stimulating megakaryocyte progenitors which cause an increase in platelets, activating hepatocytes to produce the acute phase reactants CRP and amyloid A, as well as stimulating the activation of osteoclasts which have as major role in osteoporosis. [Hashizume et al. 2011] Extra-articular manifestations in RA can affect almost any system in the body, although the most commonly affected are the skin (rheumatoid nodules, eyes and mouth (secondary Xxxxxxx’x) and lungs (pulmonary fibrosis). [Xxxxxxxx et al. 2003]