What is the significance of the clinical signs of anorexia, fatigue, and generalized weakness in the first patient?
It is important to realize that RA is a chronic, relapsing, inflammatory disease that includes the joints. While the principal target is the synovial lining of joints, the disease also affects many organ systems – skin, heart, lung, blood vessels, and muscle. The release of inflammatory cytokines, such as IL-1 and TNF-a, from the joints into the circulation can lead to the generalized systemic signs and symptoms noted in this case. As well, 80% of individuals with RA have autoantibodies (usually IgM) to the Fc portion of IgG. These circulating complexes contribute to the extra-articular signs of RA.
