Abstract
Rheumatoid arthritis (RA) is associated with a wide variety of extra-articular manifestations
and comorbidities, several of which can be organ- or even life-threatening. These
extra-articular manifestations and comorbidities can also contribute to the physical
disability and psychological morbidity of RA that lead to reduced quality of life,
higher direct and indirect costs, and societal burden of the disease. Although the
expansion of RA treatment options and adoption of treat-to-target approaches has reduced
the incidence and severity of several nonarticular manifestations of RA, such as rheumatoid
vasculitis and cardiovascular disease events, this does not seem to be shared by all
RA comorbidities. Moreover, a number of highly prevalent and impactful RA-driven comorbidities,
such as accelerated atherosclerosis, interstitial lung disease, and sarcopenia, can
present clinically in the years before the manifestation of joint pain or observable
synovitis. A larger proportion of patients with RA have atherosclerosis, myocardial
dysfunction, interstitial lung disease, and sarcopenia that is subclinical in the
preclinical and earliest clinical phases of RA, emphasizing the importance of targeting
the pre-RA phase for the prevention of comorbidities that are often poorly responsive
to treatment once they develop. Herein, we review the potential impact of pre-RA prevention
on the incidence and burden of extra-articular manifestations and nonarticular comorbidities.
Key Words
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Article info
Publication history
Published online: June 09, 2019
Accepted:
April 10,
2019
Received in revised form:
March 18,
2019
Received:
February 11,
2019
Identification
Copyright
© 2019 Published by Elsevier Inc.
