From the Guidelines
Rheumatoid nodules, particularly those observed on the skin, are the most common extra-articular manifestation of Rheumatoid Arthritis (RA), and among the options provided, the closest association would be with rubbery nodules observed on the bridge of the nose, although this is not the most typical location. The most common extra-articular manifestation of RA is indeed the rheumatoid nodule, which can appear in various locations, including the skin, lungs, and other organs 1. These nodules are more prevalent in seropositive patients and often correlate with more severe disease activity.
- Key characteristics of rheumatoid nodules include:
- Firm, non-tender masses
- Typically found over pressure points or extensor surfaces
- More common in seropositive patients
- Often associated with more severe disease activity
- The presence of rheumatoid nodules may indicate a need for intensification of the underlying RA therapy, as they can reflect a more aggressive disease course. Given the options, rubbery nodules observed on the bridge of the nose (option a) would be the finding most associated with the extra-articular manifestations of RA, although it's crucial to note that the bridge of the nose is not a typical location for rheumatoid nodules, which more commonly occur at the elbow or other pressure points.
- Other options, such as pain reported emanating from wrists bilaterally (option b) and morning stiffness reported in the knees bilaterally (option c), are more indicative of joint involvement, which is a hallmark of RA but not considered an extra-articular manifestation.
- Swelling observed in both great toes (option d) could be related to RA, especially if it's part of a larger pattern of joint inflammation, but it is not specifically indicative of the most common extra-articular manifestation.
From the Research
Extra-Articular Manifestations of Rheumatoid Arthritis
The most common extra-articular manifestation of Rheumatoid Arthritis (RA) is associated with the following finding:
- Rubbery nodules observed on the bridge of the nose, as nodules are the most common extra-articular feature, present in up to 30% of patients 2, 3, 4.
Characteristics of Extra-Articular Manifestations
Key characteristics of extra-articular manifestations of RA include:
- Presence in up to 30% of patients, with many other classic features occurring in 1% or less in normal clinic settings 2, 3
- Association with worse outcomes, including functional impairment and mortality 2, 3, 4
- Increased risk in patients with active RA, high disease activity, male gender, smoking habit, severe joint disease, and high levels of inflammatory markers 3, 4
Comparison of Options
Comparing the provided options:
- a. Rubbery nodules observed on the bridge of the nose: most closely associated with the most common extra-articular manifestation of RA 2, 3, 4
- b. Pain reported emanating from wrists bilaterally: a common symptom of RA, but not specifically an extra-articular manifestation
- c. Morning stiffness reported in the knees bilaterally: a common symptom of RA, but not specifically an extra-articular manifestation
- d. Swelling observed in both great toes: a common symptom of RA, but not specifically an extra-articular manifestation 2, 3, 4, 5, 6